In 2002, I returned to work at my prior hospital of employment and found many examples of forward-thinking in place.  One seemed like an oxymoron. A palliative care nurse practitioner was now employed within the Medical Intensive Care Unit (ICU). I wasn’t sure what to make of this addition at the time, but years later, I’ve realized the very appropriate allocation of this advanced practice nurse within this setting.

The overall death rate in the ICU is high: 20%-35% of patients admitted to intensive care die.

 In addition, admissions to the ICU in the last month of life have increased to nearly 30%.

 Within cancer care, contemporary data confirms the importance of addressing the needs of patients with cancer within the critical care setting. Consider the following:

In the past decade, up to a third of patients admitted to ICU have a cancer diagnosis.

Overall, 1 in 10 patients experience a life-threatening condition that requires the supportive technologies and monitoring rendered within the ICU setting.

The use of aggressive cancer therapies heightens the prevalence of emergent scenarios; this is especially the case in the treatment of hematologic malignancies and with the use of hematopoietic stem cell transplantation.

Associated with the increased prevalence of oncology patients within critical care settings are other corollaries. 

Within the context of patients being unable to speak on their own behalf, surrogate or proxy decision-making has a plethora of problems and controversies.

 The prevalence of considerable symptom distress is another issue. In addition to cancer treatment-related sequelae, palliative care-related symptoms (i.e., thirst, anxiety, sleep disturbance, dyspnea) also require management.

 Lastly, poor communication amongst numerous physician specialists and with family members is pervasive.

There are several interventions to be considered to address these issues. They require implementation within the critical care and oncology unit settings. Consider the following:

Establish a routine schedule for rounding with the palliative care team in both the oncology unit and intensive care settings. This includes developing a proactive approach to identifying patients who could benefit from palliative care interventions with the delineation of triggers for palliative care consults.

In the ICU setting, have a plan for routine family meetings based on the projected or estimated length of stay.

Create comfort care protocols for the management of common distress sequelae.

Consider the development of family education approaches to enhance their awareness of common sequelae they are likely to encounter in critical care.

Mandate communication training opportunities that address common scenarios likely to be encountered within critical care.

I had the opportunity to work with a research initiative within the 5 University of California hospitals to train critical care nurses in communication skills.

 The program’s goal was to provide needed instruction in the clinical setting about how to speak with the families of ill patients and the training consisted mostly of role-playing communication strategies with families, physicians, and family meetings.

Oncology nurses are one of many nurse specialties that care for patients with cancer.  Emergency Department, PACU, surgical, rehabilitation, home care, dialysis, medical, and critical care nurses care for our patients at various phases of their cancer experience. The inevitability of oncology patients being cared for, and possibly dying, in the critical care setting is a real one in today’s acute care environment. Because of the prominence of cancer today, all nurses need to ensure they have the expertise and confidence to care for oncology patients at varied points along the cancer continuum.

Angus DC & Truog RD (2016).  Toward better ICU use at the end of life. 

Teno JM, Gozalo PL, Bynum JP et.al. (2013). Change in end of life care for Medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009. 

Boyle DA, Barbour S, Anderson W et.al. (2017). Palliative care communication in the ICU: Implications for an oncology-critical care nursing partnership. 

Mercadente S, Gregoretti C, Cortegiani A (2018). Palliative care in intensive care units: Why, where, what, who, when, how. 

Puntillo KA, Arai S, Cohen NH et.al. (2010). Symptoms experienced by intensive care unit patients at high risk of dying. 

Oh YS (2017). Communication with health professionals and psychological distress in family caregivers to cancer patients: A model based on stress-coping theory. 

Milic MM, Puntillo K, Turner K et.al. (2015). Communicating with patients’ families and physicians about prognosis and goals of care. 

Fumis RR, Martins P, Schettino G (2015). The impact of poor prognostic patients admitted to the intensive care unit on family members emotional disorders. 

Wright AA, Keating NL, Ayanian JZ et.al. (2016). Family perspectives on aggressive cancer care near the end of life. 

Anderson WG, Puntillo K, Boyle D, Barbour S, Turner K, Cimino J, Moore E, … Pantilat S.  ICU bedside nurses’ involvement in palliative care communication: A multicenter survey. 

Boyle D & Anderson WG. Enhancing communication skills of critical care nurses: Focus on prognosis and goals of care decision-making. 

Articles

The stigma around palliative care is that it is only associated with end of life, and in some minds, giving up. But that isn't the case, as palliative care is a vital part of any critical care.  

Incorporating Palliative Practices Into Critical Care

In this month’s episode of CURE Talks Cancer Podcast: Nursing Edition, we had the chance to follow up with Chasity M. Washington, MPH, CHES, director of the Center for Cancer Health Equity at The Ohio State University Comprehensive Cancer Center, after sitting down with her at the 

to discuss her presentation on health equity. In this episode, we were able to talk more in-depth on how the social determinants of health affect patients with cancer and how nurses can not only advocate for their patients but their fellow nurses as well.

For more on the impact of the social determinants of health in cancer care read on here: 

https://www.oncnursingnews.com/conference-coverage/sono-2019/better-understanding-your-patients-situation

In this month’s episode of CURE Talks Cancer Podcast: Nursing Edition, we had the chance to speak with Chasity M. Washington, MPH, CHES, on how the diversity in the workplace is important to cancer care.

Championing Diversity in Nursing and Oncology

My observations over the years have led me to believe that there is a nursing hierarchy among the nursing specialties, and critical care nursing is considered by many the pre-eminent nursing specialty.  Case in point, within all general areas of nursing, the Medical ICU, Trauma ICU, Peds ICU, Neonatal ICU, are perceived to require the highest skill set of nurses. General nursing experience is often mandated before consideration of position placement within these units, hence, critical care positions itself as being a ‘cut above’ generalist medical, surgical, and pediatric nursing.

The ICU’s elevated status is directly associated with technology’s overwhelming presence in these areas. The use and manipulation of machinery are perceived to be associated with the highest level of nursing skills, and closely related to technology’s presence is heightened acuity correlated with the need for ideal ratios of nurse to patient staffing.

In the hospital setting, I practiced as an oncology clinical nurse specialist in collaboration with a critical care nurse educator on multiple projects.  This colleague, a highly skilled and long-tenured critical care nurse, decided to return to school to pursue becoming a family nurse practitioner.  One of her lengthy clinical practicums was on a general in-patient medical-surgical unit for 3 weeks.  My colleague used multiple vacation days to complete this clinical requirement and nearly a month had passed since I had seen her.  Upon one of her first days back to her educator role she asked if we could have lunch, and the reflections she shared were quite telling.  

My colleague was astounded as to the complex nature of the patients she encountered in this unit. The majority of patients were elderly, diagnosed with multiple co-morbidities, and prescribed a myriad of medications. Many of these patients could not get out of bed on their own and needed assistance with the basic elements of daily performance. Their clinical symptoms reflected a wide array of potential etiologies, many of which were not detectable from a definitive laboratory marker or radiologic finding.  She went on to share her reflection of the comparison between critical care nursing and it’s medical-surgical corollary.

In critical care, she described, abnormalities are technologically calculated on a number of platforms. Hemodynamic, urinary, hepatic, and neurologic parameters are spelled out in objective measures. The data portending demise and emergent scenarios are printed out in front of us. In medical-surgical nursing, there are no such measures to aide decision-making. Medical-surgical nurses must rely heavily on their critical thinking skills, collating and comparing numerous data sets, and past knowledge to determine and anticipate clinical scenarios.  Medical-surgical nursing she summarized, is so much harder than critical care nursing. This is exacerbated by these nurses having at least twice if not more patients they must care for in a shift than ICU nurses have.

Secondly, my personal and professional impressions also credence to my colleague’s reflections. The overwhelming influence of technology in critical care has diminished the importance of humanistic care. With the heavy reliance on machinery, comes an over-emphasis on numbers. This minimizes the importance of addressing the interpersonal distress observed in the hovering family members and the anxious patient in respiratory distress.  My clinical experiences within critical care have left me with the impression that emotional support takes a back seat to lines, tubes, drains, and pumps. 

I believe that in contemporary health care, oncology nursing has evolved into a ‘pseudo’ critical care specialty. The technology is not as pervasive as in critical care, but it is dominant in everyday practice. I worry that this could falsely place competency in managing machinery as being more important than mastering how to talk to patients and families in crisis. I have always embraced the expectation that we must be equally proficient in our interpersonal skills as we are in our technical ones. Striving for this dual excellence positions us uniquely as a nursing specialty.  

When you plan or consider attending, the next oncology nursing continuing education program, look closely at the nature of what is being presented. Is comparable emphasis given to recognizing patient suicide risk and minimizing caregiving burden to knowing early symptoms of oncologic emergencies, managing central line complications, and using personal protective devices?  Ongoing deliberation of what we are teaching will ensure that the dual domains of oncology nursing excellence are alive and well in practice.

Among the various specialties of nursing, a sort of hierarchy has formed that may be putting competency with machines over nurse and patient interactions.

Is There a Nursing Specialty Hierarchy?

I vividly remember calling the wife of a patient after the death of her husband, as I wanted to see how she was doing. I purposely waited to call a month after the patient’s death as I knew from my research with families whose loved one died in the hospital setting, that this is a particularly rough time. The cards and calls no longer come. The visitors have left, and the primary caregiver is left in an empty house to face the reality that their loved one is gone forever. I also knew caregivers find these calls particularly supportive because they feel the nurses who cared for their loved one truly know what they went through, especially when the cancer trajectory was a difficult one. This wife told me that she returned to work earlier than expected after taking a leave of absence during her husband’s treatment. She said she felt isolated and lonely in her house so she thought her return to work and the company of her co-workers would be helpful to her, but she found the opposite to be her reality.

“It was awful,” she said. “I felt like a leper. People I had worked with for years avoided me like the plague. No one even mentioned the fact that Jim had died; it was like my personal tragedy never happened. I felt even more alone than when I was at home and I was angry at my co-workers who treated me this way. I wasn’t asked to go to lunch or socialize with them like we used to do. They avoided me, I think, to eliminate the possibility that I would bring up Jim’s death and they didn’t want to talk about it. Jim’s death and my grief were topics no one wanted to talk about. I was around people I had known for years, had a relationship with yet I experienced such alienation, it was painful. I eventually quit my job and decided to try something new, go somewhere where people weren’t aware of my situation and my sadness.”

Never could I have imagined at this time, that I would personally experience this same phenomenon, not once but twice.

Following my own husband’s death from metastatic bladder cancer and my daughter’s untimely death following a tragic car accident, I returned to my work in the hospital setting. I was met with similar insensitivity from some co-workers. However, in my case, the avoidance and isolation did not come from laypeople with little exposure to and much discomfort with death. In my instance, it was my colleagues, nurses, and doctors, many of whom witness tragedy on a daily basis, who were the ones finding my presence uncomfortable. These are the people who were supposed to be knowledgeable about offering comfort to families who were suffering from the loss of loved ones. 

After returning to work following my husband’s death, I was on the elevator and it stopped on the floor housing the OR. When the door opened, there stood my husband’s urologist waiting to get on. I actually saw the discomfort on his face when he saw me. He made a brief attempt at a greeting, but he then abruptly turned saying, “Oh there’s something I forgot to dictate about my last case” and turned away from the elevator. Very similar to the patient’s wife whom I called, when I returned to work after my daughter’s death, the avoidance and isolation from the group of nurses I worked closely with was abhorrent. Not one of them ever mentioned the fact that she died, never mentioned her name or asked about my sorrow. The first time I returned to work after an extended bereavement leave, the only people who mentioned what had happened was the director of volunteer services and an administrative intern. 

I am sure there are many other comparable stories like mine.  I feel strongly that every work setting should have a support program for employees who return to work after the death of a close relative. Focus groups with employees who have personal experience with this issue would generate many ideas about what would help.

For example, it would have been very comforting for someone from work to have met me in the lobby of the hospital to welcome me back and accompany me back to my unit or if there was a card waiting for me signed by my co-workers telling me they missed me and thought a lot about me around the loss of my child. They could have had an EAP counselor come to me on one of the first days back (rather than expect me to go to them) to offer support and to determine if I might want more counseling in the future. A session with my co-workers might also have been beneficial for the counselor to discuss how to talk to someone with intense grief and how to interact with them upon my return. 

Knowing what to say and emphasizing the importance of positive communication skills might have made them less anxious about knowing how to interact with me. It could have let them know I didn’t want to hear their stories of their losses, but rather that I would have found a listening ear more beneficial. I didn’t want to keep my sadness hidden and this would have allowed me to give it a voice. Also, for me personally, it would be great to just be hugged, no words necessary.

The grieving process doesn't stop when you think you're ready to go back to work, and it can be made worse when your coworkers are unsure how to console you. Which is why workplace assistance is essential for grieving employees.   

Why Workplace Assistance is Needed For Grieving Employees

The words oncology nurses use when talking to patients and their loved ones can have a major impact on the quality of care. Using proper terminology for substance misuse disorders and being compassionate to parents whose child is facing a cancer diagnosis, for example, can set the tone for the patient-provider relationship.

In this issue’s cover story, we explore the tragic opioid crisis that is sweeping the nation and oncology nurses’ role in tackling the issue. “Nurses should have mindful social interactions with parents who have heard the dreaded words, Your child has cancer.”

 interviewed experts in the field about the stigma around opioid use, risk mitigation, and patient education strategies, as well as when it is—or isn’t&mdash;appropriate to use opioids. The article outlines key strategies for safe drug administration, which has great potential to affect patients whom nurses see day in and day out.

Although nurses should be cognizant of how they discuss opioid use with their patients, they should also have mindful social interactions with parents who have heard the dreaded words, Your child has cancer. In our feature story, we discuss the importance of compassionate care, not only with the child with a diagnosis but also with the family members and caregivers.

Nurses must be sympathetic to parents who are facing this difficult time and ensure they understand the ins and outs of their child’s diagnosis, as well as any care or consideration they should provide at home. This often requires patience, as many loved ones can have trouble digesting information after hearing the word cancer.

Also, in this issue, you’ll hear one oncology nurse discuss the reality of having cancer and how she finds motivation and inspiration from the amazing people she treats every day. And for Breast Cancer Awareness Month, we’re offering a continuing education (CE) section specific to the disease. Be sure to take the online quiz and earn 1 hour of CE credit. I hope you find this issue both enjoyable and informative. As always, thanks for reading!

Here's what you can expect from the latest edition of Oncology Nursing News®!

Putting Compassionate Care at the Forefront of Oncology Nursing

Parents often become distressed or overwhelmed when their child receives a cancer diagnosis, especially if the prognosis is poor. Nurses must be sensitive to parents’ emotional needs when providing important information about the disease and safely caring for the child at home, and a number of strategies can help guide their interactions with parents.

In 2019, more than 11,000 children will be given a cancer diagnosis, and almost 1200 children are expected to die from the disease.

 Behind accidents, cancer is the second-leading cause of death for children aged 1 to 14 years, according to the American Cancer Society. But thanks to advances in cancer research and treatment, the survival rate for children has increased over the past 4 decades from 58% to more than 80%. The Children’s Oncology Group (COG) has played a pivotal role in improving outcomes for pediatric cancer through clinical trials, research, and education.

Wendy Landier, PhD, RN, CRNP, FAAN, an associate professor in the Division of Pediatric Hematology-Oncology and the School of Nursing at the University of Alabama at Birmingham, chairs the COG Nursing Discipline Committee and spoke to Oncology Nursing News® about a structured interventional approach to optimize parent and family education and increase nurses’ satisfaction.

The intervention, which a COG workgroup developed to educate parents after their child receives a diagnosis, follows an 18-item checklist to ensure essential information is taught prior to hospital discharge.

 This checklist addresses topics including diagnosis/treatment, access to care, treatment of adverse events, infection prevention, care of the child, and home medications. Some areas, such as handwashing and taking temperature, require return demonstration.

Education must be patient/family-centered, focused on essential information first, consistent, repeated, structured, paced, and delivered according to the family’s preferred style of learning.

“Early on,” Landier says, “parents tend to be anxious about the logistics of life following diagnosis. They want to know how they’ll handle working, telling the other children, paying the bills, and managing the appointments.” The impact of hearing their child has cancer makes retention of information difficult at this stage.

Posting the COG checklist in the child’s hospital room allows nurses to know at a glance what areas have been taught and to whom, how, and when they were addressed, as well as whether a topic’s final checkoff is complete. This provides transparency, with a list that is easy to use, accessible, and empowering for nurses, as they are always aware of what areas still need to be addressed. The checklist, along with the parent guide and handbook, is available through the COG.

“Nurses are pivotal when it comes to helping families cope,” Landier stated. “They bridge the gaps by providing essential education on complex information in a way the family can best understand. It means so much to families when nurses take the time to translate medical language for them and meet them where they are.”

One of the best ways nurses can build a trusting relationship with parents is to hold space for them to feel how they feel. If they are angry or sad, hold space for that. Amy Haskamp, MSN, RN, PCNS-BC, CHPPN, CPON, clinical nurse specialist for the Pediatric Palliative Care Team at Riley Hospital for Children in Indianapolis, Indiana, and a pediatric faculty member of the End-of-Life Nursing Education Consortium, encourages nurses to align their conversations with parents’ hopes. This is particularly important when a child’s prognosis is poor.

“If the family says they just want their child to stay alive, responding with ‘I will hope for that too’ helps bridge the divide between what parents wish and what nurses know,” Haskamp told 

. She also encourages nurses to use the NURSES mnemonic, which represents “name (the emotion), understand, respect, support, explore, and silence.”

“Communicating with parents about their child’s cancer is not about explaining everything out. It’s about a family who’s experiencing an emotion. Giving more cognitive information is not going to be helpful until emotions are addressed,” Haskamp said.

Haskamp added that acknowledging what parents are experiencing helps them feel supported and respected, which in turn helps them cope with their emotions. “They want to be heard,” she said.

Nurses should tailor conversations with parents to the situation and the family’s communication preferences. If the child has always been involved in conversations about their cancer, abruptly changing this pattern may lead to worry about what is wrong.

Sometimes the family may want help talking to the child. Guiding the conversation by asking and exploring questions often opens the door to deeper communication. Haskamp said nurses must never undersell their role: “They are more valuable than they can imagine.”

1. Key statistics for childhood cancers. American Cancer Society website. 

https://www.cancer.org/cancer/cancer-in-children/key-statistics.html. Updated September 10

2. Withycombe J, Alonzo T, Wilkins-Sanchez M, Hetherington M, Adamson P, Landier W. The Children’s Oncology Group: organization structure, membership, and institutional characteristics. 

2019;36(1):24-34. doi: 10.1177/1043454218810141.

3. Rodgers C, Bertini V, Conway MA, et al. A standardized education checklist for parents of children newly diagnosed with cancer: a report from the Children’s Oncology Group. 

2018;35(4):235-246. doi: 10.1177/1043454218764889.

4. Rodgers CC, Stegenga, K, Withycombe JS, Sachse K, Patterson Kelly K. Processing information after a child’s cancer diagnosis—how parents learn: a report from the Children’s Oncology Group. 

2016;33(6):447-459. doi: 10.1177/1043454216668825.

Oncology nurses are a key part of the cancer care team, but they are also a crucial source of information for a patient's family. 

Providing Essential Education and Support for Parents of Pediatric Patients

I have recently been reading a lot about compassion. I’m not sure whether it’s triggered by a specific event or due to a long-standing interest in the interpersonal domain of oncology nursing. I have always wondered about the varying degrees of compassion I have observed at the bedside over the decades. Why are some of us so virtuous in our caring and others so distant and disconnected? Where does compassion come from anyway? Was a family member a role model for it for us when we were young or was it a profound reaction to some event we observed? And what, exactly, is compassion?

In 2017, Canadian colleagues published the results of a study in which they interviewed 53 patients with advanced cancer and asked them about their perceptions of sympathy, empathy, and compassion.

They also asked the patients what these constructs looked like in healthcare providers. Sympathy was depicted as an unwanted, pity-based response.

Empathy was perceived as an affective reaction whereby the professional attempts to understand the patient’s suffering. Compassion was the most preferred response. It was perceived to have empathy embedded in it and was distinguished by 2 unique characteristics, both relating to action rather than just feelings.

Compassionate professionals had a desire to relieve suffering rather than merely understand it. They acted on their feelings. There was an altruistic nature to their demonstrations of kindness, which were identified as going above and beyond the expected. Thus, if compassion is highly desired by patients who are suffering, we need to consider whether we can teach compassion as a necessary competency.

Contemporary neuroscientific research has identified a link between the mental and emotional foundations of compassion with brain functioning. Another study described that our brains don’t remain fixed over our lifetime and that by engaging in activities that foster connectivity and sensitivity at the bedside, we can enhance our capacity to read others’ cues and empathically respond.

A growing body of work posits that our interactions can have physiologic effects that influence healing, improve functional impairment, and relieve psychological pain.

 In the context of compassionate exchanges, we can trigger immunologic, hormonal, and neurologic processes, not just by what we say but by how we say it. Decades ago, in championing the modern hospice movement, Cicely Saunders, OM, DBE, FRCS, FRCP, FRCN, shared her insight that the power of listening and the ability to embody a compassionate presence in the face of suffering might be as important as any medical intervention.

In the book Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference, the authors speak of a “compassion crisis in healthcare.”

 In physicians, this can be characterized by brief, clinical interactions devoid of compassion, poor listening skills, and depersonalization, or the inability to connect with patients. Unfortunately, especially in teaching facilities, these behaviors may be exemplified in physician leaders and are emulated by those in training. How can we change this current problematic paradigm?

First and foremost, we must solicit more feedback from patients and families about their experiences, and we need to share these results. Years ago, as part of a grief group I cofacilitated, we asked family caregivers what it was like to be in the hospital setting when their loved one was dying. Results revealed that the nursing staff was perceived as extremely compassionate and concerned about the family’s well-being. In describing their loved one’s physicians, however, this was not the case.

The majority of comments were negative. Families felt abandoned. Their interactions with the physicians were void of compassion. They sensed the oncologists’ discomfort and saw this linked to their limited conversations, brief visits, or staying away altogether. In a subsequent cancer committee meeting, I shared this feedback with the predominantly physician group. I quoted the responses verbatim, making it hard to refute the accurateness of the comments. Little was said following my presentation, and the next item on the agenda was quickly brought forth. Despite this, I felt I had accomplished my goal, namely, to be the voice of our families and advocate on their behalf.

In a time of crisis, no one wants to be cared for by a healthcare professional devoid of compassion. I believe compassion can be taught and that this topic needs to be part of all healthcare professionals’ basic education. Subsequent skill enhancement should also be a component of ongoing education in the work setting.

I have been the recipient of non-compassionate and compassionate care by healthcare providers, over the years, mostly as a family caregiver. I can tell you that the difference between the two is palpable. Marketing the positive aspects of exemplary compassion might be a strategy to consider in motivating colleagues to embrace and learn this competency.

With compassion comes reciprocity. Personally, the extension of myself to suffer with a patient leaves me with the sense that I showed up and made a difference. What a gift. Mark Twain said that kindness is the language which the deaf can hear and the blind can see. True compassion has no limits.

Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. 

. 2017;31(5):437-447. doi: 10.1177/0269216316663499.

Contemplative Caregiving: Finding Healing, Compassion, and Spiritual Growth Through End-of-Life Care

. Boulder, CO: Shambhala Publications; 2019.

Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference

The Compassion Connection: The Healing Power of Empathy and Mindful Listening

. New York, NY: Oxford University Press; 2018.

Providing compassion to your patients won’t just help their day-to-day care, it can also change their treatment journey for the better.

The Compassion Connection in Cancer Care

This year’s depiction of “the best” hospitals generated by the 

garnered significant attention after its release. Institutions that made the coveted list were quick to buy up media advertisement space to widely market their rankings. However, on social media, I saw numerous physician commentaries stating that the criteria used for the rankings were flawed.  This made me curious about what variables were used to identify “the best” of this year’s hospital rankings when nursing is taken into consideration.

The hospitals were categorized within the 

 of outcomes and patient experience, and process and outcomes. Some examples included discharge to home, availability of technology, presence of intensivists, patient volume, patient experience, presence of select patient specialty offerings (i.e., fertility clinic, hospice, pain management, palliative care, translators, wound management) and the expert opinion by physicians. There were only 2 criteria that addressed the quality of nursing: staffing and Magnet status. 

After looking in detail at the criteria, this ranking methodology is indeed flawed. Why? Because it does not reflect the robust nature of nursing excellence that is required to be “the best” hospital in any category, and most certainly within the nurse-intensive nature of cancer care. The isolated use of nursing positions (i.e., staffing) does not reflect the quality of nursing care required to render optimum patient care. You may think, well Magnet status is taken into consideration, but that is a sign of practice excellence. Only 1 point is given to hospitals holding this prominent recognition, while all other criteria are judged on a wide spectrum with their own factors taken into consideration. Furthermore, even the top hospital is only given an “above average” for its nursing staffing while scoring “very high” or “excellent” in every other category.

Irrespective of the number of intensivists and the latest technologies, without nurses, no hospital can function. All cancer therapies and supportive care interventions require the expertise of oncology nurses to assess, treat, monitor, support, teach, and counsel patients and their caregivers in ways that physicians or other members of a patient’s care team cannot. It is timely that nurses speak up about their absence within the criteria used to measure “the best” when rankings like this are not taking crucial aspects of a patient’s care into perspective.  

A recent ranking of "the best" hospitals in the country did not take a key aspect of cancer care into proper consideration, the oncology nurse.

Taking Oncology Nurses' Roles Into Consideration When Determining Hospital Rankings

Three years ago, I never really thought about advocacy. I knew what it was, and I noticed what other providers were doing, but our practice never played an active role.

My perspective changed quickly after finding out about a policy that would dramatically cut funding for oncology practices, potentially leaving people with cancer without the care they needed. I began to see how the future of my practice—and our patients&mdash;hinged on taking action.

I started by sharing information about the negative policy with my colleagues and patients. We also developed and presented personal stories to our senators so they could understand the importance of community oncology and the devastating effects of consolidation and clinic closures on patients.

It was uplifting and empowering to learn that our elected officials 

 want to do the right thing—but knowing what that is isn’t always immediately apparent. That’s where people with real stories and experiences truly make a difference. Our elected officials need people in the community to stand up and explain why and how policies could hurt them. This isn’t always easy. Cancer is scary, and treatment can be daunting. But know that as an advocate,

you are giving patients and families a voice to help fix the system where it’s failing, so others don’t have to endure the same experiences you witnessed.

Results from your efforts won’t happen overnight—and they aren’t supposed to, so don’t get discouraged. This doesn’t make your engagement as an advocate any less important. It’s a marathon, not a sprint. Getting involved with other committed advocates and learning how you can help is the first step in achieving small, incremental wins that make a big difference.

Why does advocacy matter to me? That’s simple: my patients’ lives are at stake.

 (COA) works with practices to develop outreach programs that help us speak with a single, unified voice. COA reminds us that we are not alone in this fight. When we work together, patients, families, and providers are empowered to take control of their health care and make a change.

I’ve been in your shoes. I never thought I needed to step up and make my voice heard. I encourage you to become an advocate by getting involved with a CPAN chapter near you or reaching out to COA to see how you can get involved. I still remember the day I decided to stand up for my patients and practice and do what I thought was right.

Together, we can keep cancer care in the community and make sure cutting-edge treatment is available for all.

Kathy Oubre, MS, is the Chief Operating Officer of Pontchartrain Cancer Center in Louisiana and a board member of the Community Oncology Alliance (COA). She believes strongly in the power of advocacy and regularly raises her voice on behalf of community oncology.

Being an advocate might not only change your patients' lives but your life as well.

Giving Patients a Voice through Advocacy

Throughout my career, I’ve focused on providing personalized, quality care to my patients. Little did I know that my perspective—and career&mdash;would change dramatically after a familiar face walked into my clinic.

When my mother was first diagnosed with cancer, I wasn’t an advocate or navigator. I hadn’t had any experience advocating on behalf of patients until the 

 (COA) extended the invite to their annual conference. I wanted to get involved—for my mom, for my patients, for my practice.

I attended my first advocacy day on Capitol Hill shortly after the conference. At first, I didn’t know what to expect or how to present myself when meeting face-to-face with representatives and staffers; I wasn’t even sure I knew what to say. COA was there to guide me through the process and encouraged me to think beyond my perspective as just a nurse. Their educational resources and training webinars taught me about policies that restrict the care we try to provide.

I began to understand how insurers and pharmacy benefit managers harm patients by delaying access to treatment. The more I educated myself, the more I understood that it takes real people—myself, my mother and others&mdash;to give human perspectives that ultimately change people’s minds about potentially harmful policies.  

I advocate for community oncology so that people in my community, like my mother, can receive the affordable, life-saving treatments they need close to home. Together on Capitol Hill, my mother and I talked about the value of community oncology and what it meant to her and our family. Our representatives and their staffers truly appreciated the time we spent sharing our experiences. If there’s one thing you should expect out of advocacy, it’s to 

know that you drive change by telling your own story

It was great for me to learn that you don’t have to choose your career over advocacy. I am still able to do what I’m passionate about and care for the people at our clinic. Making time to speak with the community and educating others about the important issues we face in the clinic and cancer care community at large; makes the care I provide even more rewarding.   

Stephanie Jackson, RN, is an Oncology Nurse Manager at the Cancer Care Specialists of Illinois. She hopes to inspire others in her community to advocate for more accessible cancer care. 

Sometimes, there's only so much you can do for patients in a clinical setting. But by sharing their stories and struggles, you can drive change that will affect their clinical treatment.    

Nurse Navigation