In her first nursing skills class at YSN, Tara Walsh Malbasa '06 felt like the only student who didn't know how to take a blood pressure. A history major at Boston College with a thesis about the effect of the potato famine on the Catholic Church of Ireland, Malbasa was confident in her ability to write long research papers but not in her ability to do the technical aspects of nursing. Malbasa was straight out of college without a "second career" behind her, and the other students seemed much more experienced in health care.

Her blood pressure skills aside, Malbasa knew from the beginning that she wanted to specialize in pediatric oncology. She knew she wanted to combine her desire to work with children and her need to work with individuals with cancer, inspired in part by her mother, a nurse at Sloane-Kettering Cancer Center in New York.

Instead of impatience at not beginning her specialty immediately, Malbasa experienced great fulfillment, soaking up everything that YSN could offer in that first year in the Graduate Entry Prespecialty in Nursing (GEPN) program, and knowing that she would never have another such opportunity. She also worked as a nursing assistant on the general pediatric unit at Yale- New Haven Hospital, an experience she found invaluable as her nursing education progressed.

"What helped me most at YSN were the women and nurse practitioner role models who did amazing things," said Malbasa. One of those pediatric nurse practitioners (PNPs) was Sheila Santacroce, PhD, APRN, associate professor in the PNP specialty at YSN and expert in the field of pediatric oncology. As Malbasa's mentor and advisor, Dr. Santacroce not only provided guidance by arranging Malbasa's weekly clinical practice in pediatric oncology at Hackensack Hospital (NJ), she also advised Malbasa on her thesis about adherence to oral chemotherapy in teens with acute lymphocytic leukemia. Her thesis was published as an article in the Journal of Pediatric Oncology Nursing four months after graduating from YSN. "It felt great that my thesis went beyond a purely academic pursuit," added Malbasa.

With her grounding in evidence-based practice at YSN, Malbasa set off for Cleveland, where she now works with several other PNPs and physicians at Cleveland Clinic Children's Hospital. A typical day in the pediatric oncology clinic finds Malbasa seeing patients who are in varying stages of treatment, covering the day hospital, and being called to the O.R. to do lumbar punctures with chemotherapy, bone marrow aspirates, and biopsies. Observing that her young patients needed antibiotics more quickly than they were receiving them after their arrival to clinic, Malbasa developed "fever orders" based on the patient's fever on arrival, blood work, pre-calculated dosages, and the time that it takes to get the antibiotics from the pharmacy. The standing orders have resulted in significant improvement in the speed with which the febrile patients are treated. In October of 2008, Malbasa was asked to present her quality improvement project at the national meeting of the Association of Pediatric Hematology/Oncology Nursing, a professional group for which she is membership chair of the Ohio chapter.

About 50 to 60 percent of Malbasa's practice involves children with brain tumors. She also provides care for children with leukemia, lymphoma, bone cancer, and other cancers. While she believes it's good to be an expert in one type of cancer, she wants to be able to care for patients with a broader range of illnesses. She learned at YSN that alongside her desire to specialize early on was an enthusiasm for everything that other fields have to offer.

Children at the clinic range in age from infants to young adults up to age 30. According to Malbasa, young adults who are single have better outcomes in the pediatric clinic than in the adult clinic. They tend to move home to be with their parents who bring them for their appointments and treatments. The younger children are just like any other children in primary care practices, added Malbasa. "Even when they feel bad, kids are the same everywhere and primary care issues are still there."

Her experiences in Dr. Santacroce's weekly chronic illness seminar in her third year at YSN led Malbasa to develop a successful Sibling Outreach Program, funded last August by a national organization called Bear Necessities. According to Malbasa, families quite naturally focus on the child with cancer, leaving siblings with little attention during the course of treatment. Siblings worry and often take on caretaking responsibilities that are normally left to adults. Consequently, siblings of children with cancer experience posttraumatic stress at a rate higher than the patients themselves. The Sibling Outreach Program is an effort to address the special needs of siblings. (See http://www.cleveland.com:80/healthfit/index. ssf/2008/12/sibling_outreach_program_at_cl.html)

It has not taken Malbasa long to discover that Yale connections are everywhere. While a student, Malbasa received a Richard Frisbee III Foundation scholarship for YSN students pursuing an oncology nursing career. Last summer, Malbasa responded to a survey from the Frisbee Foundation following up with former scholarship recipients. Malbasa's description of her current work struck a chord with foundation chairman Christine Frisbee, who recently authored a collection of accounts of the experiences of siblings of children with cancer and other serious illnesses. Frisbee began the foundation after she lost her son to leukemia in 1989; although her four other children were profoundly affected by his illness, there were no resources or support groups for them to turn to.

At Malbasa's request, Frisbee was the keynote speaker at the Cleveland Clinic's first Sibling Outreach Program educational symposium held last fall. While parents listened to Frisbee and other speakers, siblings had an opportunity to share their experiences through a day of play, exercise, and fun. The family feedback about this and other programs for siblings has been outstanding.

Reflecting on her accomplishments since that first nursing skills lab, Malbasa hopes that, through her work, others can see how much it means to be a Yale Nurse. She added, "I will always be grateful to YSN for teaching me that in this profession you are able to do as much as you are willing to work for."

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