Mayo Clinic Bone Marrow Transplant Center Provides Comprehensive Care

TON - June 2020, Vol 13, No 3
(Left to right): Jessie Scholten, RN; Austyn Franklin, RN; Michel Benz, MSN, RN,
OCN; Madeline Christensen, RN, OCN; and Marissa Gilson, RN.(Left to right): Jessie Scholten, RN: Austyn Franklin, RN; Michel Benz, MSN, RN, OCN;
Madeloine Christensen, RN, OCN; and Marissa Gilson, RN.

Mayo Clinic is one of the largest providers of bone marrow transplants in the United States, having performed nearly 10,000 stem-cell transplants at its campuses in Arizona, Florida, and Minnesota. At Mayo Clinic in Rochester, MN, approximately 500 transplants are performed each year.

The Mayo Clinic Blood and Marrow Transplant Program is certified by the Foundation for the Accreditation of Cellular Therapy, accredited to perform unrelated donor transplants by the National Marrow Donor Program, and is a member of research cooperatives, including the Blood and Marrow Transplant Clinical Trials Network, Children’s Oncology Group, and ECOG-ACRIN Cancer Research Group.

The Oncology Nurse-APN/PA (TON) spoke with Michel Benz, MSN, RN, OCN, Nurse Manager, Department of Nursing’s Blood and Marrow Transplant Unit, Mayo Clinic, Rochester, MN, about her roles and responsibilities at the clinic, as well as some of the challenges and rewards related to her job.

TON: What are your roles and responsibilities at Mayo Clinic?

Ms Benz: I am the Nurse Manager of the adult Blood and Marrow Transplant/Hematology unit, Eisenberg 9-4/9-3. Our primary population is comprised of patients who undergo stem-cell or bone marrow transplants to treat their underlying hematologic malignancies. My role as the Nurse Manager is to lead and support the operations of the nursing unit, which is a 34-bed combined inpatient and hospital-based outpatient practice.

The inpatient area serves patients 24 hours, 7 days a week, and the hospital-based outpatient practice typically has patient appointments scheduled from 7 am to 9 pm daily, although it is able to triage patients after hours and care for outpatients 24/7 as needed to manage blood and marrow transplant-related symptoms.

My role includes planning, directing, coordinating, and evaluating operational, fiscal, and personnel activities to ensure the provision of continuous high-­quality care. Some of my responsibilities include hiring staff, assisting with training and professional development, creating schedules, collaborating with the multidisciplinary team regarding patient care, and completing annual reviews. I also assist with patient care as needed and administer stem cells to our patients on the day of their transplant.

TON: Are you responsible for hiring the nurses for the department?

Ms Benz: Yes, I am responsible for hiring the nursing staff. I look for passionate and dedicated professionals in the field of hematology, oncology, and blood and marrow transplant. They must have a sincere interest in working with our patients and should possess qualities of empathy and compassion. Working in the field of hematology and blood and marrow transplantation can be challenging. We offer hope and healing to many of our patients and also care for patients at the end of life. Therefore, our staff must be highly competent and have strong communication skills. They must also be able to provide holistic care.

After hiring an individual to join our nursing staff, I collaborate with the Nurse Education Specialist and Clinical Nurse Specialist on education, training, and professional development. It usually takes approximately 2 years to become fully trained into all the nursing roles on our Blood and Marrow Transplant unit. This training includes hematologic malignancy education, inpatient care, blood administration, chemotherapy training, stem-cell or bone marrow infusion training, orientation to the hospital-based outpatient practice, and finally, charge nurse training. We also support an off-site blood draw service for our blood and marrow and solid organ transplant patients at the Gift of Life Transplant House in Rochester, MN, and have a subset of nurses trained for this service.

TON: What do you consider your biggest career-related challenge?

Ms Benz: By far, the biggest challenge of my career has been navigating patients and staff through the COVID-19 pandemic. We have had to keep our immunocompromised patients safe throughout their transplant trajectory while simultaneously keeping staff safety and personal protection at the forefront.

Before the COVID-19 pandemic occurred, I would say my biggest challenge was to support and oversee a combined inpatient and hospital-based outpatient practice. The hospital-based outpatient practice allows our patients to remain an outpatient pre- and posttransplant with comprehensive care, including blood draws, nurse assessment, provider assessment, medication and blood administration, dietitian support, and social work support all in one location. It is challenging to coordinate the logistics of maintaining staffing, orientation, training, and patient care in both areas. However, it is also extremely rewarding to see the benefits of having a familiar team caring for patients in both areas, and the seamless transition that occurs if a patient needs to be admitted for symptom management. The patients truly appreciate this combined practice, and some have called it “a hospital within a hospital for bone marrow transplant care.”

TON: What are the greatest rewards related to your job?

Ms Benz: The most rewarding aspect of my job is witnessing firsthand the high-quality care we provide to our patients and to see them succeed with good outcomes so they can move on with their lives. Our patients are very appreciative, and many come back to say hello and express their gratitude. Seeing the results of the tremendous work we do is truly rewarding. I also love being a Nurse Manager and helping members of our staff grow and develop to their fullest potential. Personally, I also find it very rewarding to help with the hands-on care of patients on day 0 during their transplant infusion.

TON: Can you tell us about your career trajectory?

Ms Benz: I have been a nurse in hematology and bone marrow transplant for 17 years, since I graduated from college. My plan was to become an elementary school teacher, but 2 experiences changed that plan. During my sophomore year, my mother had a stroke, and I was impressed by the care and compassion of the nursing team who took care of her. Then, a dear friend’s father underwent an allogeneic stem-cell transplant that led to long-term remission.

I started thinking about nursing and was really drawn to oncology. I began my career as a nurse in hematology and worked in this area for 10 years. I enjoyed developing relationships with the hematology patient population and helping them through a difficult period in their lives. During this time, I became involved with many opportunities offered at Mayo Clinic, including serving on various committees, participating in a nursing leadership development program, presenting on chemotherapy administration and hematologic malignancies, and serving as an interim nurse manager. I obtained my master’s degree in nursing with a focus on Clinical Nurse Specialist. At that time, the Nurse Manager of the Bone Marrow Transplant unit here was retiring after 30 years, and she encouraged me to apply for the position. I have been in this role for the past 7 years.

Originally, my plan was to work at Mayo Clinic for a few years and then move somewhere else. However, the positive culture and strong values at Mayo, combined with the rewards of working in this specialty, have kept me here.

TON: What are you currently most excited about in the field of oncology?

Ms Benz: I am most excited and hopeful about the development of effective therapies to manage treatment-related toxicities associated with transplant, particularly severe or refractory graft-versus-host disease (GVHD) after allogeneic stem-cell transplant. High-grade or refractory GVHD can be life-threatening and the gastrointestinal symptoms, such as copious diarrhea and the inability to retain nutrition, can severely affect quality of life.

Our clinic has participated in several clinical trials to research biomarkers and effective therapies for the prevention and management of acute and chronic GVHD following allogeneic transplant, with the goal of improving patient quality of life and survival. Some therapies have been promising, such as the use of posttransplant high-dose cyclophosphamide, in reducing the incidence and severity of acute and chronic GVHD.

I am also excited about the opportunity to redesign our blood and marrow transplant hospital-based outpatient practice, incorporating small tests of change with Plan Do Study Act cycles. We are just starting this multidisciplinary project, and are exploring opportunities to improve efficiency, level load appointments, and leverage technology.

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