Stanford Health Care

Stanford Health Care (SHC) is a large, comprehensive system serving Stanford, California, and the surrounding area. The system comprises a total of 11,225 people, including 7689 employees, 1070 volunteers, 1016 interns and residents, and 1450 faculty physicians.

Stanford University is an academic medical center, and the cancer institute is designated by the National Cancer Institute as a Center of Excellence. SHC includes ambulatory clinics and community practices that are collectively referred to as the Stanford Health Care Alliance.

The Oncology Nurse-APN/PA spoke with Laura Zitella, MS, RN, ACNP-BC, AOCN, Lead Advanced Practice Provider (APP)/Nurse Practitioner (NP) for Inpatient Hematology/Oncology about her role at SHC and her experience there. Zitella is the first recipient of the APP of the Year Award presented by the APP General Council and the Center for Advanced Practice at Stanford.

What does your job entail as Lead APP for the Inpatient Hematology/Oncology APP team?
Laura Zitella (LZ): I supervise a team of 12 nurse practitioners who care exclusively for cancer patients admitted as inpatients at Stanford Hospital. At Stanford, there are 4 medical teams to care for inpatients with cancer: an oncology resident team, a hematology resident team, a combined/APP bone marrow transplant (BMT) team, and our NP hematology/oncology team.

Our team, called MED9, was created in 2012 in response to the increased volume of hematology/oncology patients. It is the first medical team at Stanford to include only NPs who provide medical care in collaboration with the attending physician. Our team model has been very successful with excellent patient outcomes and high ratings of patient satisfaction and continuity of care. As a result, this year we expanded our team from 8 to 12 nurse practitioners and from 3 to 4 attending physicians to accommodate an increased patient volume.

I developed the structure for our operations, and I interview, hire, orient, and train the staff. Currently, 50% of my time is spent providing patient care and the other 50% is administrative and involves managing the clinical operations for our team and ongoing professional development of our staff.

What are the most challenging aspects of your job?
LZ: It turns out that the most challenging aspects are also the most exciting for me. I would say the main challenge is keeping current with all the advances in oncology—implications of genomics and identification of new targets for various cancer types. This involves using my clinical judgment regarding the best treatment for each patient and optimizing supportive care.

My goal is to give patients the best experience possible, making sure that in addition to the medical treatment, our team addresses the supportive care needs and emotional needs of our patients.

What is the most rewarding aspect of your job?
LZ: Developing a relationship with patients. It is an honor to meet each patient and help that person and his/her loved ones through a very difficult journey, giving them guidance and advice.

I also find mentoring my staff very rewarding, helping them develop new skills and witnessing their transformation into expert clinicians.

What led you to pursue becoming an oncology APP?
LZ: I always had a strong interest in science and also a strong desire to make a difference in the lives of others. I knew pretty early on that I wanted to be a nurse practitioner. I have been doing this for 18 years.

Tell me about the award you received. I believe it was the first one awarded at Stanford.
LZ: The award was given to me in 2014 by the Center for Advanced Practice at Stanford. The Center oversees all of the APPs at Stanford, including NPs, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists.

The award was in recognition of my contributions to SHC. The main ones are creating the first APP inpatient team; developing comprehensive onboarding and orientation for all APPs at SHC; coediting a book with MiKaela Olsen called Hematologic Malignancies in Adults, published in 2013 (the definitive textbook for hematology published by the Oncology Nursing Society); cofounding the Stanford Advanced Practice Council in 2008 with Tracey Mallick, NP; creating a quarterly APP newsletter; obtaining privileges for APPs to order chemotherapy independently according to the attending physician determined treatment plan; coediting the Stanford Oncology Handbook; giving educational presentations at local and national scientific meetings; and creating the annual conference held at Stanford called “Topics in Acute and Ambulatory Care for APPs.”

Has the award changed your life?
LZ: It is one of the biggest honors of my professional career to be recognized by my peers. I am grateful for the opportunities that have been available to me at Stanford, working with such dedicated, compassionate, and accomplished colleagues.

What are your professional goals for the future?
LZ: My main professional focus is the mentoring of new APPs and nurse practitioner students. I have been a volunteer clinical professor at University of California San Francisco School of Nursing since 2003 (Stanford doesn’t have a school of nursing), and I precept students in the clinical setting and present a hematology lecture every year.

I am also excited about another project at SHC. Stanford is in the process of designing a cancer hospital that will optimize the patient experience, and I am part of the core team that is involved in this initiative. Right now we are in the design phase, and we expect the cancer hospital to open by 2022.