'Patients are always her focus'

Pat Groff was ready to end her short nursing career before she walked through the doors of the Hutchinson Center in 1976. The then 21-year-old had always wanted to be a nurse, but her yearlong stint in a general hospital had left her disillusioned by a setting where it seemed that rigid rules and bureaucracy came before patient needs.

"From the first time I set foot in the Center, I knew I wanted to work here," Groff said. "As far as I'm concerned, this is a nursing dream job, and it always has been. Why would I work anywhere else?"

Though the Hutchinson Center had only opened its First Hill doors the previous year, Groff immediately sensed a culture unique in health-care settings. "We were never treated as 'just a nurse,'" she said. "We were always listened to by the doctors, and there's always been this incredible respect of us all being in this together."

As treatment, technology and survival odds for cancer patients have vastly improved, Groff is happy to be celebrating three decades of nursing at the Center. And she's grateful still to be working in an environment where patient-centered care and front-line experience are valued. Her patients and new and experienced nurses alike, who cherish Groff's humor and teaching skills, share that gratitude.

Nurse manager's mentor

Groff began as an inpatient nurse, a role she held for 17 years. Back then, in the earliest days of bone-marrow transplantation, the nursing staff was responsible for all aspects of patient care during the many months treatment required. "It was cutting-edge medicine, and it was exciting to be a part of something totally new," she said. Nevertheless, Groff had to quickly come to terms with the reality of an average of only 15 percent to 20 percent survival for the patients.

"Pat was instrumental in helping me deal with the emotional impact of working with these patients," said Rosemary Ford, nurse manager of the Seattle Cancer Care Alliance's Transplant Clinic. Groff trained Ford in 1978, and Ford later became her manager in 1993. "I had no experience with oncology and was struggling with the almost immediate and severe complications of our treatments on patients who looked fairly well when they arrived," Ford said. "I still remember Pat telling me that these patients had made a choice to do everything possible to fight to live, and their life expectancy without transplant was only six months to a year. It was the context I needed to hear."

Outpatient care

Groff has bonded with many of her patients through the years. Her husband recently remarked that they receive more Christmas cards from her former patients than they do from family and friends. She remembers one of her first patients, a 14-year-old with aplastic anemia. "She was awfully close to my age at the time, and her mom was young, too, and we just had a great time during her care," Groff said. "The first time I saw her, the sun was shining on her and she looked healthy and beautiful, but she was desperately ill." The young girl survived her transplant but later died. Groff stayed in contact with the family for many years and memorialized the patient's name as part of her baby daughter's name.

Weary of seeing patients succumb to cancer, Groff made the decision to switch to outpatient nursing in 1993. She has worn many different hats, but currently serves as a team nurse in the SCCA Transplant Clinic. Multiple teams consisting of an attending physician, a primary provider and a nurse cover 11 to 19 patients at any given time, with an average of four months' care. Groff and the other nurses are responsible for assessing and teaching patients and coordinating tests and outpatient care, a role she summarizes as "clinics, conferences, telephone calls and paperwork."

'Everybody's mother'

She loves time spent talking with patients one-on-one, but admits her job often pulls her in many directions. "It's hardest when it's really busy and 95 people want my undivided attention," Groff said. "It's like I'm everyone's mother. With everyone coming at you at once, it's hard because I want to meet everybody's expectations."

A favorite part of Groff's job is patient education. "We have to ensure everything is done so patients can be taken care of safely at home," she said. "At other transplant centers, the things we do on an outpatient basis would be inpatient, but we teach them how to care for themselves. I pass on all the tricks I've learned from my patients on how to manage issues like medication and nausea. It's all these different things that people have never done before, so we teach them what to expect so they aren't alarmed or surprised, and they can deal with it."

While Groff's patients learn a great deal from her, oncology nursing has taught her life lessons as well. "It does affect your viewpoint," she said. "You know, old cars and leaking basements don't mean quite as much." She's also learned not to delay dreams. "My husband and I are traveling now. We're not saying, 'When we retire, we're going to do this and this.' We're doing it now because there might not be that retirement. If there is, that's good!" she said.

Life lessons from patients

In the early years of transplantation, only patients under 30 received transplants. As the transplant age rose over time, Groff valued the perspectives of older patients. "They're used to doing what they need to do every day, even if they don't feel like it," she said. "You know, you might not feel like going to work or taking care of the sick kid, but you've got to do it. So you get up every day, and you just do what you have to do. That ability is missing in younger patients because they haven't lived a long time. For my patients with a lot of life experience, the bumps aren't so high, and the lows aren't so low. So when I get tired, I think of them and keep going."

Groff is one of a handful of SCCA nurses who have worked side by side for decades. "We've done transplant nursing together for more than 30 years," said colleague Eileen Rossman. "We've really grown up at the Center. After all these years, Pat still comes to work and energizes me. She is quite the resource, always reading new protocols and nursing literature because she continues to want to be the best in her field by keeping updated. She gives a perspective that is usually different from the rest of the crowd, so we listen when Pat talks."

Ford agrees with that assessment. "Pat is a natural teacher, and I — probably unfairly — assign most new nurses to her for their orientation. She knows how to break down complex concepts so the new nurses can understand at their own pace."

"Most importantly, Pat's priorities are based in the best patient care. She is genuinely interested in her patients first as people. If she ever has extra time in her very busy days, she spends it with patients, going beyond the have-to-dos to the nice-to-dos. Her patients are always her focus."