At large children’s hospitals, there are doctors at all levels of training—from first-year medical students to experienced professors of medicine. It’s often hard to sort them all out in the chaotic early days after diagnosis. This section describes each type of doctor you might meet at a large children’s 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 (i.e., Doctor of Medicine) after their 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 four weeks.

A fellow is a doctor who has completed residency training and is now focusing on a particular specialty. Most fellows you encounter will be specializing in pediatric oncology.

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. They have completed a residency and a fellowship program. 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 any member of your family-centered team.

I’ve been very lucky that our doctors have been very open with us. When Samantha was first diagnosed, our doctor spent two hours explaining and answering our questions, and it has never stopped. Even if we haven’t asked, but the doctors notice concern in our faces, they sit and take the time to find out our worries. They’ve all been great—the nurses, hospital, and support staff.

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 earlier in this chapter). However, make sure your insurance will cover care at the institution you choose.

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 hospitals, 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, and change bandages. 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 (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.

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 hospital, your first step in resolving the issue should be to talk to the nurse involved. If this does not fix the problem, the next step is a discussion with the charge nurse.

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 on that unit.

At our hospital, each of our nurses is different, but each is wonderful. They simply love the kids. They throw parties, set up dream trips, act as counselors, best friends, and stern parents. They hug moms and dads. They cry. I have come to respect them so much because they have such a hard job to do, and they do it so well.