" Angee Kilmer, BSN, RN-BC, nursing supervisor of radiation oncology for the University of Kansas Cancer Centers and c

Kilmer said that she heard the same question when she worked in transplant. Now, the radiation oncology nurse explained that patients with cancer are extremely kind and grateful, despite the difficult treatments that they are often going through. Being an oncology nurse opened her eyes to how loved ones can rally around a patient, and she said that she sees "real, down-to-Earth humanity" in what she does. 

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Oncology nurses are often faced with the question, "Isn't your job depressing?" Hear what what radiation oncology nurse had to say.

Nurse Answers: Is Your Job Depressing?

Oncology nurses can get creative when it comes to helping patients who face financial toxicity, explained Angee Kilmer, BSN, RN-BC, nursing supervisor of radiation oncology for the University of Kansas Cancer Centers and 

When patients are having trouble paying for their medications, it is crucial that they talk to someone on their healthcare teams -- and that person is usually an oncology nurse. Nurses should always be open to the conversation, and assure the patient that there are things they can do to help, be it asking for samples or finding drug co-pay assistance programs. 

Oncology nurses must ensure that patients are discussing issues they face when it comes to paying for medication.

Nurses Get Creative When Addressing Financial Toxicity

Before attending a recent nursing retreat by LinkedIn’s Community Activation Team, the organizer asked the attendees what the most significant issue in nursing was today. The attendees were applicants of LinkedIn’s “Future Leaders of Nursing” program, FLoN’s for short (ironically, referencing Florence Nightingale). I was honored to be accepted as one of the applicants chosen who are described as, “nurses with a passion in their field, a desire to teach and learn from the communities that surround them.” Those of us selected are from all over the United States and hold a multitude of roles: from entrepreneur to nursing director, from new graduate nurse to a PhD prepared researcher; and came from every specialty throughout healthcare: medical device, intensive care, informatics, cardiology, education, oncology, and long-term care to name only a few. Though the path each nurse traveled was different, they all seemed to have witnessed the same issue no matter where they were: burnout.

We were all appreciative when we learned that the organizer booked a workshop about burnout. The speaker, Kristina Leonardi, began the session with exercises that asked us to look inward at ourselves, ironically, not addressing anything about nursing or our careers, just asking us to look at ourselves. We wrote down our likes, dislikes, hobbies, etc. — the usual feel-good things for a detailed, social media profile. At first, we thought this was a bit strange since we were all there as nurses at a nursing conference. In fact, all we wanted to do at the beginning of the day was to meet the other nurses we had come to know in the LinkedIn group, learn more about their nursing practices, get practice input, and give and receive nursing advice. We were all so excited to finally meet one another and then the momentum seemed to be brought down by taking the focus away from nursing.  

One of the questions we were asked was: “When you were a child, what did you want to be when you grew up?”. As an 80s kid in a town with a population of 400, I wanted to go on adventures like 

; I wanted to learn about other places and the people there, so I wanted to be an archeologist. Later, when I decided that would be too dangerous, and having romanticized a life in “the city,” I decided I wanted to be an architect. I thought it would be fabulously urban and chic, until I found out how many hours they worked and how cut-throat the competition was. Then, a myriad of life experiences — including having my first child – led me to the profession of nursing and I have not looked back.

Then I made the connection between what I do now and what I dreamed of doing as a child. I thought deep down to the core of why being an archeologist or architect were so appealing. I wanted to be an archaeologist because I wanted to be an investigator who discovered people’s stories. I wanted to be an architect because I wanted to inspire using creativity. “Wow,” I said to myself, “I get to do this every day as a nurse!” I am doing exactly what my heart has longed for. When I staff in for my team, my investigation is assessment of a patient’s history, family dynamic, education level, and care coordination. This is especially important for oncology nurses as our patients have so many elements of care to navigate. As a front-line nursing supervisor, I use creativity in my approach with my nursing team to be inspired to strive for excellence.

This realization gave me a renewed vigor for what I do “for a living.” What I am doing as an oncology nurse and as a leader is what my personality has been drawn to over an entire lifetime. For me, this understanding is a key piece in a solid foundation to remain resilient in the face of burnout, or, more appropriately, moral distress — which is a whole other article. I hope that sharing this realization can inspire oncology nurses as it did me.

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Growing up, I wanted to be an archaeologist or an architect. But as a nurse, I found that same sense of adventure.

Destined for Nursing: Linking the Past With the Present

Now that 2019 has arrived, what does this new year mean to our oncology patients?

For those deep in their treatment journey, a new year can mean it is finally time to exhale. They were blessed with one more holiday season among their loved ones, but the future is still uncertain. For those with a new diagnosis, a new year means this is the start of a year unlike any other, filled with a new routine and the word “cancer,” but also with a surge of hope because there are nurses and providers like you who will do all they can to get them through this year with comfort and support. Then again, New Year’s Day for our patients may not even be Jan. 1; it may be the date that they were finally able to leave the word “treatment” back at the hospital and look forward to a new word: “survivorship.”

Commission on Cancer lowered the percentage

 This move gave cancer centers a moment to exhale, but no time for rest as the work is only beginning. Fifty percent is not enough for our patients.

No matter the disease process or geographic location, all patients should receive the same standard of care. As anyone familiar with delivering SCPs (including registered nurses, advance practice providers, and other providers) can tell you, the desire is there, but 

varying education on when or how to provide an SCP and

the complex patient path through surgery, treatments, and multiple providers which leads to confusion in which “team” should be providing SCPs

While adding a new process or task to nursing staff is quite difficult, doing the right thing for the patient should not be. What is the missing key to keeping accredited centers from playing catch-up so that their quality and accreditation teams can sleep at night?

The American Cancer Society explains that cancer should be treated as a chronic disease after treatment.

 Consider a similar case: diabetes, a chronic disease that crosses all specialties and types of nursing. Imagine a patient admitted for diabetic ketoacidosis and a new diagnosis of diabetes. Upon discharge from crisis, we would prepare the patient with the best tools and education to stay well. We would involve a diabetic educator, dietician, and social worker, and refer the patient to the appropriate outpatient provider. Decades ago, interventions like this used to be “going above and beyond” for a patient with diabetes. Now, it is standard of care after stabilization.

Nursing care for a patient with diabetes includes widespread, standard education not just for diabetic educators, but for each and every nurse who encounters these patients. Every nurse can spot the need for education or care intervention and can refer the patient to a specialist, the diabetic educator. Diabetic educators have a wealth of information that assists patients in overcoming financial and social barriers to quality chronic disease management. A hand-off then occurs to another provider, or better yet, a medical home that will help their patient be their best. Finally, let us not forget that throughout these steps, nurses are educating and empowering the patient, who is the most important care team member.

So, what would it look like if in the scenario above we replaced diabetes with cancer (which may not be so farfetched, because the number of survivors is booming, increasing by the millions

)? All oncology nurses would have basic education on survivorship. It would be routine to access the SCP to check that a patient is following the prescribed plan. If a patient seems to be struggling with the plan, we would call in a specialized nurse educator to help refer the patient to the correct resources and get them to a provider who understands that an SCP is as vital as an insulin regimen to reference. Finally, all along the way, the patient becomes more and more educated and empowered to understand and carry out the SCP so that they are at their best.

To push SCP delivery to 100%, we need to begin to view survivorship through the same lens as any other chronic disease. When we do this, we will understand that the SCP is not the end, but a guide to the beginning of a new cancer chapter. Providing SCPs is largely in nurses’ hands, and we should take up the mantle to shift the focus on them and the understanding of them. Nurses, when we hear that bell ring, let’s continue to cheer and clap for the end of the battle; but now, let it also be the starting bell for a call to action to champion the chapter of cancer survivorship.

Important information regarding CoC Survivorship Care Plan standard. American College of Surgeons website. facs.org/quality-programs/cancer/news/survivorship

Managing cancer as a chronic Illness. American Cancer Society website. cancer.org/treatment/survivorship-during-and-after-treatment/when-cancer-doesnt-go-away.html

 Published February 12, 2016. Accessed January 12, 2019.

Cancer statistics. National Cancer Institute website. cancer.gov/about-cancer/understanding/statistics. Updated April 27, 2018. Accessed January 12, 2019.

Building momentum for implementing survivorship care plans for all.

Nursing Call to Action: Survivorship Planning

Angee Kilmer is the nursing supervisor of Radiation Oncology for the University of Kansas Cancer Centers. She is a member of the Kansas City Chapter of Health Information and Management Society and the social media board chair of the Heart of America Chapter of the American Nursing Informatics Association. Currently pursuing both an MSN and MBA, Angee is an aspiring leader at her institution. Outside of radiation oncology, her interests include systems improvement and leadership development.