Happy Oncology Nurses month to all of the amazing bedside clinicians, advanced practice providers, professors, and academic researchers! This year has proven to be a transformational year that marks the 200

 birthday anniversary of Florence Nightingale, as well as the 18

 year of nurses being recognized as the most honest and ethical professions. Until this year, oncology nurses have been the only specialty among nursing that has been recognized by a professional organization as a one-month celebration.

From the moment a patient is diagnosed with cancer, nurses are there to provide the priceless gift of presence. They listen as patients lay in bed with fear behind their eyes of, “Why me? What about my spouse and children? What am I going to do about my financial obligations? Will I die from this disease?” It is nurses who whisper in the steal of the night shift, “We will take it one day at a time” and offer encouragement that is often never forgotten. 

As the treatment plan is determined by the physicians, it is the nurse who eloquently provides ongoing teaching of the chemotherapy regimen, symptom management, and non-pharmacological treatments. The nurse is the liaison who provides advocacy and a bridge to the medical team to communicate the holistic needs of the patient. When the patient can’t begin to comprehend the information the doctor provides regarding statistical analysis of their disease, it is the nurse who  possesses the ability to facilitate open-ended questions that convey the patient had no idea what was just communicated to them. 

And even as the trajectory of illness may prove to be unfavorable, the nurse is often the last healthcare professional bedside the dying patient to ensure a peaceful death. They provide pain relief and symptom management to ensure the last memories of the family are meaningful despite the transition to palliative instead of curative care. Nurses provide the final bath to ensure the dignity of the patient remains obtained; coordinate donation of organs if eligible; and facilitate a safe transfer to the mortuary.  Even as the family prepares to exit the hospital for the last time without their love one, it is the nurse who offers therapeutic condolences to remind a family they weren’t “just another patient.”

It is without saying, that a nurse is “not just a nurse.” From the bedside to the boardroom, nurses are leaders, practitioners, scientists, and transferors of knowledge. The longevity of care that oncology nurses provide is insurmountable and is the true essence of a job worthy of recognition. 

Stephanie Jackson is co-editor in chief of Oncology Nursing News and a nationally board-certified clinical nurse specialist specializing in oncology and bone marrow transplantation. She is currently the clinical nurse specialist for the hematology/stem cell transplantation units at a large academic medical center in Los Angeles, California. She has over 2 decades of nursing experience which includes various positions such as acute care, ambulatory, academia, home health, and hospice. She is a member of several professional nursing and community organizations. Some notable mentions include the National Council of Clinical Nurse Specialist, Association of Clinical Nurse Leaders and Oncology Nurses Society. She is the former president of the Greater Los Angeles chapter of Oncology Nursing Society and is currently pursuing her doctorate at Grand Canyon University in Phoenix, Arizona. It is without doubt that her passion for oncology patient stems from her own experience and survival of childhood cancer. 

Articles

From the bedside to the boardroom, nurses are leaders, practitioners, scientists, and transferors of knowledge.

Not Just a Nurse

A 65-year-old patient presents with a hematologic malignancy complaining of acute abdominal pain, lack of appetite, and diarrhea. He had an allogeneic transplant 9 months ago and has been admitted to the hospital 8 times over the last 6 months. The medical team and nursing staff have tried on multiple occasions to discuss code status and medical plans for the future. The patient diverts all medical questions to his wife, despite having capacity to make decisions. The patient has been married for 40 years and has expressed the desire to please his family. The nurses have often expressed their frustrations among each other saying: 

“Was this patient the best choice for transplant? “

“Why didn’t the team tell this patient the truth?” 

“Why is this patient still a full code?”

“Maybe we should call for an ethics consult?” 

“Are we REALLY doing what’s best for the patient?” 

This scenario represents moral distress that is often experienced by oncology nurses. Moral distress is defined as an emotional state that arises from a situation when a nurse feels that the ethically correct action to take is different from what he or she is tasked to do.

 This concept has become one of the leading causes of nurses leaving the profession or their institutions. Nurses can experience lack of empathy and job dissatisfaction, while organizations may have increased turnover among staff as well as suboptimal patient outcomes. According to the literature, moral resilience reduces the prevalence of distress and creates an environment that promotes ethical reasoning within an organization.

Strategies to promote resilience must first begin with executive leadership creating a culture that supports their employees.

 Education must be provided that promotes effective communication skills, mindfulness, and emotional intelligence. And finally, ongoing professional development across all disciplines must be implemented to recognize as well as address situations that staff to experience moral distress.

Stephanie Jackson is co-editor in cheif of Oncology Nursing News and a nationally board-certified clinical nurse specialist specializing in oncology and bone marrow transplantation. She is currently the clinical nurse specialist for the hematology/stem cell transplantation units at a large academic medical center in Los Angeles, California. She has over 2 decades of nursing experience which includes various positions such as acute care, ambulatory, academia, home health, and hospice. She is a member of several professional nursing and community organizations. Some notable mentions include the National Council of Clinical Nurse Specialist, Association of Clinical Nurse Leaders and Oncology Nurses Society. She is the former president of the Greater Los Angeles chapter of Oncology Nursing Society and is currently pursuing her doctorate at Grand Canyon University in Phoenix, Arizona. It is without doubt that her passion for oncology patient stems from her own experience and survival of childhood cancer. 

Rushton, C. (2017). Moral distress and building resilience. 

. https://magazine.nursing.jhu.edu/2017/02/moral-distress-and-building-resilience/

Rushton, C., Schoonover-Shoffner, K., & Kennedy, M. (2017). A collaborative state of the science initiative: Transforming moral distress into moral resilience in nursing. American Journal of Nursing, 117 (2), S2-S6.

Stephanie L Jackson, RN, BMTCN, MSN, AOCNS

Articles

Not Just a Nurse

Moral Distress and Choosing the Best Care Plan for Patients