Photo caption: Nurse practitioner Nadia Culibrk, pictured here with a patient, joined the hematology oncology department at HHS Juravinski Hospital and Cancer Centre after completing a one-year fellowship with the team.
Hamilton Health Sciences (HHS) is home to the first fellowship program in Canada for nurse practitioners (NPs) wanting to specialize in complex blood diseases like leukemia, lymphoma and multiple myeloma. That program is now celebrating its fifth anniversary, and has proven to be an innovative way to build the stem cell transplant program at HHS.
“As the first Canadian fellowship in this field, we’re well-established leaders in education and mentorship for this specialty training,” says Kari Kolm, nurse practitioner fellowship lead.
For many years, fellowship training programs were reserved for doctors interested in building advanced expertise in a specific area of care like oncology, cardiology or surgery. More recently, they started being expanded to other medical professions, including NPs, and HHS led the way by launching the Ron & Nancy Clark Nurse Practitioner Fellowship in Hematology in 2020. It was the first such program in Canada, and aimed at new NPs with the goal of recruiting them to work in the highly specialized hematology department at HHS Juravinski Hospital and Cancer Centre (JHCC).
Four NPs have completed the one-year fellowship so far, with three accepting jobs at JHCC caring for patients with blood diseases. The number would likely have been higher had it not been for interruptions caused by the COVID-19 pandemic.
Niche training for NPs
NPs are among the most highly qualified nurses in the country, with two years of additional training at the masters level after completing a registered nursing degree. They perform many of the same tasks as doctors including diagnosing illnesses, ordering tests, prescribing medications and managing treatment plans. But NP masters programs tend to focus on family and community medicine rather than specializing in complex fields like hematology, says Kari Kolm, a longtime and highly experienced hematology NP at JHCC. Kolm helped launch the NP fellowship program five years ago and is the program’s lead.
Caring for Patients with Complex Blood Diseases
Patients with blood cancers often require intensive, highly complex treatments like stem cell transplants or CAR-T cell therapy, where the person’s own modified immune cells are used to fight cancer.
“It’s an honour to partner with patients on their cancer journey,” says nurse practitioner Cassandra Cotic, fellowship grad.
“HHS is a leading teaching, research and cancer care hospital, so providing this one-year fellowship is an excellent way for new NPs to develop expertise in this highly niche area of care,” says Kolm.
The fellowship launched in tandem with the opening of the Ron and Nancy Clark Stem Cell Transplantation and Cellular Therapies Unit at JHCC, which allowed the hospital’s cancer program to care for many more patients needing these treatments.
“With this expansion, we had incredible growth in our program,” says Kolm, adding that JHCC draws complex hematology patients from across the region and beyond. “We needed more NPs but their training, which is geared mainly toward primary care, didn’t match the advanced skills our patients require. Bridging that gap is what inspired the fellowship program.”
From the ED to Cancer Care
NPs Nadia Culibrk and Cassandra Cotic are the most recent graduates of the fellowship program, which they completed in October. Both were emergency department nurses before returning to school to train as NPs and then becoming fellows. They now work full-time in JHCC’s complex hematology department.
“It’s an honour to partner with patients on their cancer journey,” says Cotic, who works with the team specializing in leukemia and stem cell transplants. “These are life-changing diagnoses for our patients, and I’m grateful to be part of their care.”
“Our fellowship provided the advanced training we needed for this work,” says nurse practitioner Nadia Culibrk.
Culibrk is on the lymphoma team, caring for patients receiving CAR T-Cell therapy and stem cell transplants.
“These treatments are extremely specialized areas of medicine,” says Culibrk. “Working with this patient population requires unique and specific knowledge, including post-transplant care. Our fellowship provided the advanced training we need for this work.”
Blood cancer care is an area that’s rapidly evolving thanks to leading-edge research. “HHS is a top Canadian research hospital, so our patients often have early access to promising new therapies not yet on the market,” says Jennifer Smyth, director of Regional Cancer Programs at JHCC. “Given the specialized nature of what we do, a large part of our NPs’ role, including our fellows, is to deliver these promising new treatments.”
Role Models Provincially, Nationally
JHCC’s complex hematology department currently has 14 NPs on staff now that Culibrk and Cotic have joined the team. The department will open applications for 2026/27 fellowships in spring, with October as the start date.
Fellows have protected time that’s formally reserved for learning, research, continuous quality improvement projects and professional development without being pulled into other day-to-day tasks.
Though graduated, Culibrk and Cotic continue to work on their research project which focuses on how teams communicate with each other in the era of Epic, the hospital’s state-of-the-art electronic medical records system. It’s a qualitative, descriptive study, meaning it uses interviews or observations to give a clear, straightforward description of people’s experiences or opinions, without testing a theory.
Meanwhile, what started as a recruitment project for JHCC could benefit other hospitals provincially or even nationally.
“NPs from other parts of Ontario and Canada are welcome to apply when we start accepting applications in spring,” says Kolm. “As the first Canadian fellowship in this field, we’re well-established leaders in education and mentorship for this specialty training.”