They work with the sickest children in the hospital, the ones who've been given one more chance at life: a transplant.

The staff of the blood and bone marrow transplant unit at the University of Minnesota Amplatz Children's Hospital ( may care for up to 24 patients at a time. They include physicians, nurses, social workers, pharmacists, a dietitian, physical and occupational therapists, child and family life specialists, a chaplain, and nursing station technicians with dual roles of nursing assistant and health unit coordinator.

Every worker counts

Although nurses make up the majority of the staff, "every single person who's here is extremely important," said Ann Hagerman, nurse manager of the unit. "It's not just about nursing. That's for sure."

Transporters take children to and from the radiology department, and an environmental services worker keeps the unit clean.

"We need to be extremely clean and hyper-vigilant about the atmosphere the kids are in" because chemotherapy wipes out the patients' immune systems before transplants can take place, Hagerman explained.

Most diagnoses fall into one of two groups: hematologic malignancies, or blood cancers; and non-hematologic malignancies, such as tumors. About 25 percent of patients have metabolic disorders. Patients receive either a bone marrow transplant or fetal cord blood.

A busy place needs well-trained nurses

It's also the busiest unit in the hospital, according to Kent Nygaard, the day charge nurse who has worked on the unit 17 years. Each nurse is assigned two children to care for per day, and nurses with bachelor's degrees and acute-care training are preferred.

"It needs to be someone that's going to be able to be focused and be able to multi-task," Nygaard said. "We do hire a lot of new grads, but we're picky. We put them through a six-month training period. They may not get the sickest kids, but after they get out of their orientation, we try to challenge them with those kids also."

New staff must scale a high learning curve and be able to deal with families at the most stressful time in their lives. But Nygaard said he was drawn to this work "knowing that miracles can happen."

And they do. The best times are when patients who have recovered come back for a visit. "We learn from every child who comes in here and we get better from what they teach us," Hagerman said. "The survival rates are getting much, much better."