5 Questions with Preceptor Pat Cobb
Cobb, a pediatric hematology-oncology nurse for nearly 44 years, received UVA School of Nursing’s Lifetime Outstanding Student Preceptor Award in 2018 for her exceptional work as a mentor to nursing students. While she’ll retire in August after a nearly 44-year career, over the last 20 years, she's been a preceptor to CNL master's students, 3rd and 4th year BSN students, as well as end-of-life students in the School's palliative nursing course.
Why does she precept?
"When you’ve been doing the same thing for years, even as the work changes, [having students to mentor] makes you stay on your toes," says Cobb. "It reminds you that you’re always learning. I love that. It keeps me interested. Nursing’s not boring; you might wear yourself out, but you’ll never get bored."
"Many of my students hear 'pediatric cancer' and think, 'Oh, so many people die.' Well, actually, no, they don’t. Among our patients, 80 to 85% are going to do well. So it's my job to make nursing students aware that it’s not a death sentence."
Patricia Cobb, RN, pediatric oncology nurse and preceptor
What big messages do you impart to your students?
Many of my students hear "pediatric cancer" and think, “Oh, God, so many people die.” Well, actually, no, they don’t. Among our [pediatric patients], 80-85 percent are going to do well. At any one time, there are about 250,000 American childhood cancer survivors. So I make sure students understand that they need to know about survivorship, and the sometimes long-term problems these kids will have. So it's my job to make nursing students aware that it’s not a death sentence.
Too, in pediatrics, it's also understanding that while you work with children, you also work just as closely with grandparents, parents, divorced parents, second families, and all the social things that go along with that. Nuclear families have become unusual. Those social aspects of treating a child, in my opinion, are a lot harder than they used to be, and that’s what burns nurses out – when the mother’s yelling at you about something, or you go in to draw blood from the baby, and the grandma says, “Well, how many times are you going to stick him?” You have to deal with that and not take it personally. People are rightly very protective of their children, they see you as invasive as the ones hurting them. So you have to build up trust and a relationship with the family, and not just the kid. That's really important.
Another thing is confidence. Young nurses have to look like they know what they're doing. If you’re not real sure, you suck it up. Don’t go into a patient visit looking scared, or tense, because if that parent thinks you don’t know what you're doing, you’ve lost.
[To counter that], a lot of times, we practice [with students, before entering a room with patients], especially if it’s going to be difficult, and we know it. We say before we go in, “What are we going to say? What are we not going to say? What are trigger points for this family?" Or if I have a kid who screams, and that’s their way of dealing with the situation... I talk to my students about it before we go in. We never want to send them in there raw.
[It's a universal experience for new nurses to be] scared. I want to make my students as comfortable as they can be.
You've seen a revolution in cancer care during your career. How do you stay on top of things?
The changes -- truly, you almost can’t keep up. You have to constantly be learning, constantly be reading. When we started out, we did chemotherapy on the counter. You got a Laminer Flow Hood, and we mixed the chemo ourselves. Today, I teach a chemo-biotherapy class, and one of the things I like to point out is that so many of the drugs we’re using now we used back then, but now the administration is difference. Today, it’s biotherapy, like when you’re taking the patient’s cells, engineering them, and then putting them back to attack the cancer. That’s the future.
Who do you consider your mentor to be?
I was so fortunate to have a physician who taught me how to draw blood, do IVs, taught me how to mix chemotherapy. There were several doctors that took me under their wing. I was really fortunate. I still keep in contact with him. When he left, I mourned.
As a pediatric nurse, do you have secret weapons you use to help kids get through exams and treatments?
I'm not knocking it, but I tend not to be the bribe person. I use humor, and a no-nonsense approach. Like this morning, we have a little boy who’s autistic, we get along just fine, and when he was acting up, I said to him (hands on hips), “What you thinking about, boy?” and he responded with a smile.
Sometimes we have parents who are thinking only, "my child has cancer," and they let them get away with murder. I've told parents: "Your kid's going to live. And you have to live with this kid. You better remember that." Maintaining discipline as much as you can, because kids need to know what's expected of them. We also try to do things in the same order. Blood pressure first. And if you get things out of order, the kids let us know. And we let them decide something things, like, with a port [into which chemo drugs are infused], do you sit up? Lie down? Sit on mama’s lap?
I think for young nurses [being disciplinarian] is very difficult -- you always want to be the good guy. I remember that very well. But kids respond to expectations. I get on them sometimes, but they respond. And many times, they’re so proud of themselves when they do what's expected. I find, that opposed to giving them something, the praise, and the recognition [makes them feel great]. We tell everybody [what they've done], and a lot of times the docs say, “I heard you were so brave today.” Kids love that.
What piece of advice do you give to nursing students?
More than anything, it’s to try not to close your mind off when you come to nursing. Don't necessarily say that you have to do peds, or OB. As you go through school, keep your mind open. I was the oldest of six girls, I babysat my whole life – I was never going to go into pediatrics. But I fell into it, and God, look what I’d have missed? If my mind had been closed, if I hadn’t taken that part time job look what I’d have missed -- 44 years of wonderful.
Make sure you’ve seen everything. Don’t be afraid if you work somewhere for a year, and then make a change. You’ll still take away knowledge from your experience, and don't be afraid to make a change if it's not for you. Make sure you keep your eyes open. There are just too many things out there for nurses.
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