Katy was sixty-one, she’d worked as a manager on a hospital oncology unit for fifteen years, having been a staff nurse in the same oncology unit for ten years before that. She’d endured management shakeups, mergers, converting to electronic health records, and the changes from the Affordable Care Act. She weathered the daily ups and downs of staffing ratios, data and patient satisfaction scores, and turnover of what had once been a staff of forty nurses at any one time on her unit.

She looked forward to retirement at 65, but she wasn’t financially prepared for it yet. She knew that at 65 she’d still have to work at least part-time for a few years beyond that just to stay financially solvent.

After a short vacation, Katy came back to work one Monday morning and was greeted by her boss, “Can you meet me at my office at three?”

At three o’clock she walked into her boss’s office, as she had done a thousand times. This time, a different effect, almost a blank gaze met her instead of the usual greeting as her boss began talking.

“I’m not sure you’re doing everything you can to get those scores up. It seems that you’ve been different lately, and senior management is wondering if you even know how to do your job.”

Katy felt the taste of adrenaline in her mouth and her entire face began to tingle. She wondered for a second if she was having a dream, but the conversation was happening. Feeling the blood rise into her face, she wasn’t sure that she actually heard all of the words coming out of her boss’s mouth.

Her boss’s voice brought her back. “I’d like you to sign here that we had this conversation, and I want you to meet with HR on Wednesday to discuss your performance improvement plan.”

Scanning the paper with her eyes, Katy tried to hold back a deep sigh as she signed. Standing up, she felt wobbly on her feet. Somehow, she made it back to her office without having to talk to anyone, turned off the lights, locked the door, and crumbled into a crying heap in the corner chair.

After a few days of processing what was happening, Katy was shopping for groceries when she ran into a former colleague who had retired from the same hospital. “How are you holding up?” her colleague asked. As they started talking, Katy could not hold back the tears. Trying to pull herself together, the colleague said, “I am so sorry this is happening to you. That’s what they did to me. I don’t remember my self-esteem ever being so low after that experience. I ended up taking early retirement and I got out of there before they fired me.”

Katy’s eyes and ears were wide open. Her friend continued, “They’ll pull this performance improvement thing and then they’ll ride you on every little thing until you get so flustered and overwhelmed that you screw something up or just quit.” She explained they are doing this in all the hospitals now, trying to cut costs. If they can have one less manager and make one person do three people’s jobs, they’ll do it.

“They don’t care how long you’ve worked. They won’t make it easy for you.  My advice would be to talk to your financial planner and get out of there, the sooner the better, so the stress won’t eat you alive.”

A growing number of nurses are older and vulnerable to the upheaval that a pre-retirement job loss can bring. It used to be that if you saved and took advantage of any matching retirement plans your employer offered, managed your spending and saved well, you could expect to retire comfortably. You could expect to work until you chose to retire, whether that was at 65 or some other age. Many people still assume they will work their job until retirement age and retire with their financial plan intact.

We can no longer count on that. Along with the rising age of full retirement in the U.S., there is a growing gap between the time workers stop earning their highest level of income and the time they retire with full Social Security benefits and the safety net of Medicare.

Age discrimination is real, and it can be hard to recover if your new job does not compensate you as well as the old one. Women are at risk of even more age discrimination than men¹, and with women making up the majority of oncology nursing this is a major issue for all nurses.

Having a backup plan and a good financial planner is essential. What would you do if you lost your job tomorrow? How would you re-finance your entire life? Do you know a competent professional who could help you get back on your feet? 

There’s also the emotional component. How would you handle a blow to your identity as an oncology nurse?

If you love oncology nursing, are there other places where you could continue doing this? Nonprofit organizations in the community? Hospice? Home care? Starting some type of service for people with cancer and their caregivers? Or would you seek something else?

NewsHour PBS. Women over 50? Help not wanted. PBS. 

https://www.pbs.org/newshour/show/women-over-50-help-not-wanted

. Published January 15, 2016. Accessed September 13, 2019.

Articles

Retirement planning often never goes according to plan, but many oncology nurses are facing a retirement dilemma forced upon them by decisions from the higher levels of their respective health systems.  

Are You Ready for Retirement Before You're Ready?

A few weeks ago, Washington State Senator Maureen Walsh made an indiscriminate comment about nurses playing cards all day. It caused an uproar among nurses online, and within days, a social media group called Nurses with Cards was launched. It now has over a quarter million members.

As I’ve watched this issue morph into something unexpected, I’ve also observed the dynamic within the group that holds lessons for oncology nurses.

At first, the outrage was the pulse of the posts in the group, and as national attention was drawn to the gaffe and the response by nurses, the tone of the online posts changed. Ordinary nursing-related posts started to appear. Members started to ask questions that ranged from nursing skills to ethical and legal questions. Some new nurses even asked if their feelings about on-the-job experiences were normal.

Nurses—especially new ones–need a safe place to confide in other nurses and receive feedback and support that they may not be getting in the workplace. Time isn’t always provided for them to receive mentoring, feedback, and debriefing after difficult or traumatic experiences at work. They need help, but they don’t always know what they need, or at what time. They can feel overloaded easily. It takes years to build confidence and comfort with newly acquired knowledge and skills.

I thought of newly diagnosed patients with cancer in their state of overwhelm and need for support and information at a time when there is no room for more input. The state of not knowing where to go, whom to trust, what resources would be most helpful, or at what time, compounds the difficulty of the experience. Like our patients, new nurses are scared and vulnerable. They have a big job to do. Can we care for our new nurses as well?

As oncology nurses, we have a special job and duty to our patients to help them through a terrifying experience in their place of vulnerability. The need for validation that their feelings are normal, and that they have somewhere to go to get questions answered and their concerns heard, is what new cancer patients and new nurses have in common.

We wouldn’t ever expect a newly diagnosed patient to handle everything that comes their way at once. Can we do the same for our fellow nurses? Why should we treat our new nurses—or even our seasoned ones–like they need to shoulder the entire load?

Nurses need support from each other to do their best. We’re already working ourselves to the edge. Let’s help bring each other back a few steps so we’re not in danger of falling.

Like our patients, new nurses are scared and vulnerable. They have a big job to do. Can we care for our new nurses as well?

A Lesson for National Nurses' Week

On March 7, the National Nurse Act of 2019 was introduced in the 116

 Congress as a bill. HR 1597/S 696 calls for designation of a Chief Nurse Office of the US Public Health Service, who would be a publicly visible leader to address health disparities and set goals for better public health.

Cancer is one of the key health conditions listed in the bill’s language, as it has a massive impact on public health and our economy. Nurses provide the direct services needed to improve outcomes around chronic disease and cancer prevention, early detection, treatment, and management. We educate the public on preventable risk factors, teaching them to reduce their risk. According to the National Cancer Institute, 38.4 percent of the population expected to have cancer at some point in their lives

. Our role in supporting this bill as oncology nurses is crucial to its success.

Elected leaders need to hear from nurses on the front lines of patient care. We are trusted, our voices matter, and we will be heard. Nurses are the voice of health promotion and we are in an ideal position to influence and lead national conversations and policy around healthcare. 

There is evidence of the effectiveness of how visible leadership around cancer-related public health messages can positively impact the public’s participation in prevention efforts.

What can oncology nurses do right now to further these efforts? Get involved.

 to learn more about the bill. There is link to a convenient summary at the top of the page.

2. Contact your senators and representatives in Congress right away. If you don’t know who they are, go here to find your representative: 

https://www.house.gov/representatives/find-your-representative

Senators for your state can be found here: 

https://www.senate.gov/general/contact_information/senators_cfm.cfm

3. A simple email is a good start, but to be even more effective, gather as many nurses and citizens in your district to write them too. The more letters they get on a particular issue, the more they will pay attention. Urge them, in your letter, to co-sponsor HR 1597 (House of Representatives) or S. 696 (Senate).

4. Find out who your representative’s healthcare staffer is. Writing directly to the staff member is helpful as well; you can always copy them both on an email. This will be your main contact when you have any healthcare issue you want to bring to your Representative’s attention.

Nicole Barnett, DHSc, MBA, RN, CNL is a member of the National Nursing Network Organization Advocacy Team. She succinctly emphasizes the importance of this bill, "The prevention of chronic disease is at the core of the solution for the rising cost of healthcare in our country.  Of all the important healthcare related legislative efforts currently underway, none explicitly speaks to the important role that nursing leadership plays in shaping national healthcare policy the way that the National Nurse Act does. Designating the Chief Nurse Officer of the USPHS as the National Nurse for Public Health is timely, appropriate and impactful.”

Your voice is needed to elevate the profile and visibility of nurses now. Your patients’ lives depend on it.

1. National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database, 2013-2015 data https://seer.cancer.gov/statfacts/html/all.html

2. Cram, P., Fendrick AM., Inadomin, J., Cowen ME., Carpenter, D., Vijan, S. 2003. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect.  

How to Advocate for the National Nurse Act of 2019

About a decade ago, I was fortunate to have a pair of oncology nurses who helped me rise in my career. They were not my coworkers, but they mentored and supported me when I first made a career change to oncology after being an ICU nurse. I had been interested in oncology since nursing school, and at the time, my dad’s recent cancer diagnosis also got me thinking I should learn more.

As a daughter and a nurse, I wanted to hear what patients were experiencing in their lives outside of the clinic or hospital. I wanted to know how we could do a better job of helping people going through cancer, and all that goes with it — the everyday life experiences of patients that nurses and doctors don’t see in the clinical setting. Before I left critical care, I began attending support group meetings in the hospital basement for cancer survivors and their caregivers in the community.

The group was led by three women, two of whom were oncology nurses working outside the hospital setting. Bonnie and Lisa were warm, caring, and open. Their honest and knowledgeable approach helped people find answers and solutions. They did the extra footwork that went beyond what patients got from their medical treatment team. 

They brought in local speakers who talked about different topics of interest to the group, connecting the patients and caregivers to resources and people in the community. They kept everyone focused and on track, moving along through topics so that the session didn’t deteriorate into a venting or chit chat session. They were willing to stay late and talk with patients who had specific issues they wanted to discuss privately.

They also helped make connections between people (who agreed to do so) who might be able to help each other, which was a way of delegating their own work. They always followed up by making sure people got their questions answered, pursued the resources, or made the connections. Their resourcefulness was probably their greatest gift to the group.

After attending for a while and making the switch from ICU to oncology, they invited me to speak as part of a panel, and then by myself. I spoke many times to the group after that, on various topics, mostly around physical activity and wellness. Even after I left the hospital to start my own business around survivorship needs, they invited me back and started promoting my community classes and projects.

In the clinical setting, nurses on the unit would generally call a social worker or case manager or counselor to come talk with the patient. Bonnie and Lisa showed me how you could help people outside of the clinical setting, and how to engage people in improving their quality of life by making social connections and finding ways to access resources they didn’t learn about during their medical treatment. Their work served an important need and filled a necessary gap in complete cancer care.

If you’re seeking a mentor, or wanting to mentor another nurse, here are some important parts of the mentoring relationship, for both parties:

Observing and modeling behavior is the key, so remain professional, nonjudgmental, and demonstrate good people skills in all communication.

Learning to delegate when it’s appropriate and ensure follow-through. Teach others to do the same.

Building trust through honesty, openness, and warmth.

Allowing the learner to practice skills, make mistakes, and allow for improvement.

Providing constructive and timely feedback for the learner, and answer questions.

Establishing, forming, and maintaining professional relationships, both in the mentoring relationship, and with important others outside of that relationship.

Finding opportunities to move forward and grow professionally, and personally.

No one learns everything they need to know about nursing in school or on the job alone. The aim of nursing is to be able to improve the patient or client’s overall quality of life and well-being whenever possible. Nurses depend on each other to pass on wisdom, which benefits nurses and patients alike, and solidifies the positive aspects of our profession to accomplish that aim.

No one learns everything they need to know about nursing in school or on the job alone.

Nurse Mentors Help Move Careers Forward

How many times has this happened to you: It’s your first day off after several consecutive 12-hour days, but your boss scheduled a mandatory department meeting at 7 a.m. The thought of having to wake up at your usual time, get dressed, and drive into work just for an hour meeting when you’d rather stay home in your pajamas and slowly sip your coffee makes you want to hide under the covers, quit your job, or run away and never come back.

What if you could attend and participate in the meeting while at home, allowing you to sleep an extra hour or more?

My favorite technology that I use every day in my work is a videoconferencing platform called Zoom. While I use Zoom in my own business with clients and colleagues anywhere in the world at any time, Zoom can be used by nurses in a variety of work settings and roles to reap numerous benefits.

I have tried other similar videoconferencing platforms and have found Zoom to be the most user-friendly, reliable, and economical. It requires only a device—laptop, phone or tablet&mdash;a wireless connection, and an email address to use it on both the caller and recipient ends of the call. It provides a quality audio and video experience and allows screensharing and options for security and privacy of the group, with breakout public or private chat rooms.

Here are just some of the ways I’ve used Zoom in my own business, working with cancer survivors in my community, or private clients across the country:

Meeting with private clients one-on-one or in groups to discuss their concerns and questions

Meeting with other nursing professionals one-on-one or in a group to collaborate on projects, event planning, or mastermind sessions

Giving and receiving constructive criticism on preparing talks or speeches

Collaborating in development of teaching materials or continuing education offerings

Mentoring other nurses in a private, uninterrupted setting

Talking regularly with my publisher and writing coach when I was writing my book

Participating as a presenter in international online conferences, teaching exercise classes, work-related meetings with companies across the country

Holding support groups where all the participants can see and hear each other and interact as if we were all in one place

If you work in a clinical healthcare setting, Zoom can be used for work meetings; teaching and clinical education; professional collaboration such as research or writing papers; preparing for conferences and presentations; or holding roundtable discussions that can be recorded and shared online. If you need to speak with a mentor or mentee, it’s an opportunity to talk when you’re away from distractions of the work day, something for which most organizations don’t provide formal time.

The evolving practice of telemedicine is already using similar platforms. If your scope of practice and organizational policy allow it, it is possible to perform limited assessments, symptom management, troubleshooting, and conversation or counseling with clients.  Voice, facial expressions, and body language provide more information about the client’s condition than a phone call.

Additional benefits of using this technology include

solving problems as they come up such as illness, transportation, child care issues, and bad weather

face-to-face accountability to colleagues, even if you live and work far away from each other

Group meeting participants have the option of muting the audio or even shutting off the video if you don’t want to be seen. If you’re like me, you sometimes work in your pajamas or workout clothes.

The benefits of using videoconferencing technology like Zoom are far greater than convenience. We can reach beyond our immediate surroundings to collaborate with other nurses and professionals across the country or around the world. It allows us to refresh our minds, spark new ideas, hear different points of view, and see beyond the biases and groupthink of being limited to only our own immediate organizational culture.

By building connections, support, and relationships, we have a wider array of solutions to the many problems we encounter in healthcare on a daily basis. This type of collaboration affirms our common values, challenges, and needs, and links us closer together, providing support for each other in ways that were not readily available in the past. The potential for creativity is limitless.

Videoconferencing can be used by nurses in a variety of work settings and roles to reap numerous benefits.

Videoconferencing Technology Opens a World of Creativity in Nursing

I have never been one to celebrate the holidays, but I do appreciate the contrast of bright lights against the long night in December. I spend a lot of time outdoors, and this time of year I enjoy the cover of darkness to reflect and pay attention to my needs for the coming year.

I give myself gifts, but not at the holidays. I spread them out over the entire year, and those are gifts of self-care. I learned from a wise mentor before I started nursing school that the only way to survive nursing was to take care of myself.

I use 3 self-care techniques to keep me going, and they each recharge me for different aspects of my work. These are all necessary whether you work in a clinical setting, or in the community, as I do now.

Nursing requires time on my feet, standing or walking for long periods of time, in between extended bouts of sitting (think “documentation”). I get daily physical exercise, which comes in the form of running and walking. It gives me endurance for those long, upright days.

Over the New Year holiday, one of my favorite rituals is to participate in an ultradistance run called Across the Years. This year, I will be moving forward for 24 hours, which gives me plenty of time to reflect on the year behind and think about what I’d like to see in the year ahead.

Nursing is mentally taxing. It requires focusing on details while keeping multiple bits of information in my head, and the ability to recall those details after being interrupted multiple times, even after many hours when fatigue sets in. It’s important to let go of the things we worry about, wish we did differently, or can’t control, and allow peace and stillness to overtake the space that is occupied by daily concerns.

I take time to stop, lie still, close my eyes, and clear my mind. I use a combination of restorative yoga and meditation techniques to allow myself to release the mental burdens that manifest themselves in physical discomfort. Nurses experiencing any type of physical pain can often benefit from these practices.

Nursing lays bare the struggles, pain, and vulnerabilities of the many patients and clients we serve. Our unique perspective on the lives of others as we work to relieve their suffering is a gift itself.  We relate to their pain. We can also realize the contrast with our own reality where we are fortunate enough to be free of those struggles in our own lives. We not only appreciate the human condition and see ourselves as part of it, but we can more clearly see the parts of our own lives where they are intact and functioning well.

I am fortunate and thankful that I can go home to my family, my dogs, and my comfortable home at the end of my work day. Taking a moment to remember that, along with a slow, deep breath, before I get out of my car in the driveway, has become a part of my routine.

I wish you all an enjoyable holiday and a peaceful and happy new year.

I give myself gifts, but not at the holidays. I spread them out over the entire year, and those are gifts of self-care.

Gifts for Nurses that Last All Year

Oncology nurses often find themselves in the position of having to answer important questions from patients and family members. These questions usually have much lengthier explanations than the nurse has time for. Since our job is education, we use employer-dictated shortcuts like pre-approved brochures and special medical handouts printed off the computer.

Most patients tell me they never read most of the handouts they get; it all goes in a pile somewhere and gets lost until long after the information is needed. Therefore, it’s important for the nurse to find creative ways to get the message across.

When nurses feel like they are repeating the same information all the time, it becomes routine: We devise shortcuts, and it becomes easy to inadvertently leave out important concepts that need better explanation for the patient, as it is the first time they have heard the same message that we can recite in our sleep.

The message needs to be in a place where it will be seen, heard, absorbed, and remembered. In your unit or infusion center, bulletin board displays or posters can be hung in waiting areas to teach patients and caregivers. Repeated exposure can help get the message across, too. 

 are an ideal medium because they allow the user to watch and rewind to repeat information that was missed.

I decided to take on a personal video challenge during the month of November, to share cancer information with patients and caregivers. Motivated by the 

 where aspiring writers are challenged to a month-long, binge-writing streak toward completion of a novel, I decided to create a series of livestream videos on Facebook each weekday.

We all need to challenge ourselves at times and step out of our comfort zone. My comfort zone does not include being in front of a camera, so I decided that is what I was going to do, speaking as much as possible from the heart, with very few notes, and the camera holding me accountable, as videos are unable to be edited once they are uploaded.

For my project, I set up a series of short videos about improving cancer literacy for the layperson. This is important because of the widespread misunderstandings, myths, and misconceptions around basic cancer facts. People don’t bother to learn about cancer until it slaps them in the face with a crash course.

My goals for this video series were to answer some of the most common questions around cancer for those who might be curious but afraid to ask, and to teach people some useful tips on how to prepare in advance, as much as possible, for an unexpected cancer diagnosis, either for themselves or their loved ones. 

If you feel like the information your patients are receiving isn’t being absorbed or remembered, start looking for other ways to communicate these concepts effectively. You can save patients an enormous amount of frustration, confusion and time, and you might even save lives. Make sure you can do this without violating the policies of your institution and always be sure to let people know it’s not medical advice.

To see my livestreaming series, you can visit the 

I decided to take on a personal video challenge during the month of November, to share cancer information with patients and caregivers. I created a series of livestream videos on Facebook each weekday.

Creative Media and Messaging of Cancer Information

Nurses can play important roles as advocates within the greater world of healthcare, which includes physicians, allied health professionals, and decisionmakers. We can work together to advocate for systems that are ideal for all of us to serve patients, and work with each other, effectively and with compassion.

Here’s a scenario: A patient diagnosed with breast cancer is told about her treatment recommendations—mastectomy, chemotherapy, and radiation&mdash;and referred to the surgeon on a day that the breast care nurse is on vacation. The surgeon tells her she can have reconstruction immediately with expanders placed during mastectomy surgery, necessitating fewer procedures.

Normally, the nurse would have educated the patient on a range of reconstruction options and tell the patient there is no need to rush into reconstruction immediately. The patient in this situation feels overwhelmed and rushed, feeling that surgery must be completed and a decision made imminently, causing her a great deal of distress.

While the patient may feel confident in the treatment recommendations, she has missed out on important information for decision-making. If the oncologist and surgeon don’t value the nurse’s role enough to ensure that the nurse is able to participate in the consultation, the patient could be making an important decision without all the relevant information.

There is a hierarchy within the world of healthcare and nurses are not at the top. That does not mean we can’t be the first to build bridges. No one is going to help bring us equity or respect in the system if we don’t ask for it. It’s up to us to climb up the ladder to talk with these groups as colleagues. If we don’t want to be underlings, we need to start talking to other professionals at their level instead of backing off in deference and fear. Expect respectful, timely, reciprocal communication.

In the scenario above, the breast care nurse must communicate the importance of his or her role to everyone, including staffing decisionmakers—which ultimately benefits the oncologist&mdash;the surgeon, the healthcare system, and the patient. How could the physicians address the problem of the nurse’s absence? Perhaps additional staff are needed to fill the gaps for vacation time. Another breast care nurse could be hired, the process could be modified to ensure that the patient never misses the education piece before seeing the surgeon, and attention to the patient’s needs would be preserved in the process.

Nurses can commit to forming working partnerships with other healthcare leaders, even policymakers and legislators, by finding the things we have in common with them—improvements that we can pursue for mutual benefit. When others know that we understand their pain, they will be more likely to trust us and reciprocate the effort. When we advocate not just for our own position, but for the entire system, we will make progress.

Start by finding influential leaders who are personable, treat you with respect, and follow through on what they say. They need to engage in conversation as well as effort. “Busy” is no excuse for dismissing a colleague’s concerns. Everyone is busy. Everyone needs to be willing to share the workload, in mutual commitment to the greater good.

If finding common ground is an issue, make sure everyone understands what everyone else needs, what is not being met by the status quo, and what the consequences are for the patients. No one can escape responsibility for sharing the workload.

Instead of shying away from tough conversations and building bridges, nurses need to take an active role because we do not practice in healthcare alone. Every decision made is going to affect us and our patients. We cannot act by ourselves, but no one is going to do it for us. Nurses need to step outside of our traditional worlds. We can take control of our profession.

As Nurses, We Must Advocate for Ourselves

Six Ways Nurses Can Advocate for Patients

This is the third in a 3-part series about nurses as advocates within healthcare.

Advocating for a Better Healthcare System

How many times have you thought at work, “There has to be a better way to do this!”

 annual conference held in Las Vegas, and I realized that 

 are taking the healthcare world by storm. Naturally gifted with the qualities required for success-talent, resourcefulness, creativity, knowledge, education, experience, and skills-no nurse takes on a task halfway; they go over and above with 100% dedication and commitment.

Nurses go into business for many reasons, but most cite the desire to provide solutions to problems that are not being solved in traditional healthcare, wanting to provide better services and quality of life to the clients and patients they serve.

A weekend of immersion in the energy and enthusiasm of this wave of innovation left me recharged for taking my own ideas forward. It was simply the best conference I have ever attended, with the most timely, useful, practical, and professionally relevant set of offerings I could have asked for. It is truly an investment in personal and professional growth, as well as a door to connect with a huge number of fascinating, creative, and welcoming people.

Many attendees do not yet have businesses but are interested in starting one. The conference offers building blocks for those with no business experience, who are new to entrepreneurship. The offerings are aimed at nurses with a range of entrepreneurial experience, from dreamers and new business owners, to advanced topics for experienced business owners. I met other nurses who have started businesses in bereavement care, patient advocacy, case management, coaching, and product development, in addition to seasoned authors, speakers, podcasters, and social media mavens!

Nurses in business truly see each other as assets. We all want each other to succeed, and success is contagious! I left this conference with new colleagues I never even imagined I’d meet. I encourage all nurses who even have an inkling of going into business to attend this conference. I won’t miss it again!

The sessions I attended were on social media marketing skills for nurse-owned businesses, podcasting (easier than you think!), and how to advance your career as a professional speaker. In the speaking session, I learned how to begin networking with the right people to obtain speaking engagements, how to market myself more effectively as a speaker, how to charge for my services, ways to improve on my speaking, how to deliver a great presentation, and how to avoid many of the pitfalls of starting out.

I have an action plan and have set some new business goals for myself through the end of this year and for 2019. I will be using the skills I learned right away to make changes to my profiles on LinkedIn and other platforms, reaching out for guidance from speakers’ organizations, presenting a series of live videos, and reaching out to my new acquaintances. I already have formed a small group to ensure our mutual accountability to the action plans and goals we formed from the conference.

Perhaps the most important thing I took away from the conference was expanding my network with other professionals who share my passion for better care. It always helps to have support and a little cheerleading from the sidelines!

Nursing schools and professional specialty organizations would do well to reach out to organizations like the National Nurses in Business Association. The future of nursing is in entrepreneurship. Nurse entrepreneurs have been in the system, see the flaws, and want to fix them. They have more efficient, creative, compassionate, and economical solutions for better delivery of care.

A weekend of immersion in the energy and enthusiasm of the National Nurses in Business Association annual conference left me recharged and ready to take my own ideas forward.

Nurse Entrepreneurs Take the Healthcare World by Storm

Nurses must advocate for our own roles. We must influence support systems so we are able to provide safe and effective care for patients, which is a top priority in our work.

Practices and policies in the workplace can dramatically impact a nurse’s ability to provide care for patients. Here is a list of practices for which nurses can and should advocate to make work safer, more effective and satisfying, and less stressful.

Reasonable, safe, and tolerable working conditions

. This should include but is not limited to adequate 

, proper training and technical support, availability of breaks, time for stress management, mental health support, decompression, and emotional support after traumatic incidents.

 These can include mental health days, sick pay, and vacation pay. Organizations such as 

Inclusion and representation on hospital boards and committees.

 These groups make decisions that affect our work and workloads. Think of the number of nurses working at your hospital compared to overall staff numbers and you will realize we comprise a huge number of staff and should be represented proportionally. Grassroots organizations can often be more representative of working nurses, where larger organizations sometimes will defer to administration and management priorities. Search social media for the hashtags #NursesTakeDC and #ShowMeYourStethoscope for more information.

 Nurses should not be pressured to work while sick or injured. Search social media for the hashtag #ExcuseSickNurses for more information.

Protection from and recourse for workplace violence. 

These are actions against nurses and healthcare workers by either patients or family members. 

 is an organization that protects healthcare workers before, during, and after an assault. Search social media for the hashtag #SilentNoMore for more information. 

Enforced policies against lateral violence.

 There should be a culture of respect from administration, physicians, and other staff. “

 is a blog by Beth Boynton, RN, MS, that aims to help healthcare staff improve communication and the work environment in general.

Encouragement of responsible, professional portrayals of nurses in the media

. This can be in the form of television, entertainment, images, and news, both in print and online media. Reporters who are looking to write articles on certain topics often reach out to physicians when they could be asking nurses, which would give nurses’ voices more impact and visibility in print media. 

 aims to challenge nurse stereotypes and educate the general public about the value of nursing. 

 is a media resource nurses can join to be called upon as subject matter experts when journalists are looking for sources.

Speaking out in the workplace can be intimidating or difficult. You can get involved in a larger organization where you can safely air your thoughts and get support without identifying you to your workplace. Establishing connections with other nurses, especially on social media and outside of your workplace, will help.

Local media may be unwilling to cover issues that reflect poorly on their major advertisers, such as healthcare organizations. It may be hard to get them to report on topics related to nurse advocacy. 

It is empowering and very satisfying to feel you are part of the solution. Even if you feel afraid to speak out on certain issues, talk to people outside of your immediate work area, or nurses you know in other places. Discuss the issues with them, find out how they feel, or if they have witnessed effective advocacy efforts. You can also write letters to your representatives in Congress or state legislatures. The Oncology Nursing Society has advocacy courses for continuing education that apply toward recertification. While it takes time and patience, establishing rapport, developing a relationship, and building trust with a member of your workplace’s administration is important, and you will be listened to more readily.

This is the second in a series of 3 articles about nurses as advocates.

Alene Nitzky is an oncology nurse, author of 

Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care

, Blue Bayou Press, 2018. She is a cancer exercise trainer and health coach, and is CEO/Founder of Cancer Harbors

Alene Nitzky, PhD, RN, OCN