Mindfulness has been studied and proven to have a number of benefits on our physical and mental health. Mindfulness is the act of being present and aware of our surroundings while having a neutral response.

 Practicing mindfulness can offer the average person relief from a number of different life stressors. It can make a world of difference for caregivers of patients with cancer who are balancing their personal responsibilities with their loved one’s needs often with minimal support, which leads to caregiver stress and burnout.

Caregivers are often our unsung heroes of the cancer experience. Although not going through cancer treatment itself, caregivers walk alongside their loved one during a journey that can last anywhere between a few months to a lifetime. Studies show people caring for a loved one with cancer have a shorter yet more intense caregiving experience compared to people caring for a loved one with a different type of illness.

Within this intense experience, cancer caregivers can often find themselves physically and emotionally exhausted. Their lives do not stop just because they have become a caregiver, and so they need to adapt and find ways to navigate an even greater amount of responsibilities. Caregivers help their loved ones with activities of daily living, learn new medical tasks, and often coordinate services for their loved ones that do not leave much time left over to care for themselves.

This lack of time can lead to poor physical health for caregivers, and changes in sleeping or eating patterns, as well as increased feelings of anxiety and depression. Many caregivers do not notice these patterns until they feel completely run down and burnout.

Research has found mindfulness can have a great positive impact in many different areas of our lives. Mindfulness can help decrease feelings associated with burnout, such as anxiety and depression, as well as improving other symptoms such as lack of sleep or gastrointestinal issues.

 These benefits can all lead to a caregiver having a more positive outlook, which, in turn, can lead to better health outcomes for themselves and their loved ones.

Caregivers might share that they do not have the time to practice mindfulness or maybe feel like they don’t know where to start. If your caregivers are not talking about self-care, you may have to be the one to start the conversation. You can remind them that the idea of mindfulness can be intimidating when getting started but it is important to not let it discourage them.

You can start with encouraging your caregivers to set aside dedicated time to practice in a quiet space with no distractions. If it is hard to find time to set aside, that’s okay too, because they can be mindful anywhere. A person can be mindful on a walk home, while eating dinner or listening to music. Take a moment to remind caregivers before they make the decision to begin this practice that the goal is not to keep the mind from wandering, because this isn’t always possible for us as humans.

When they catch their mind wandering, encourage them to acknowledge it and bring focus back to the breath or whatever they chose to focus on.

There are so many different types of meditations we introduce caregivers to help them integrate mindfulness into their daily routines. Progressive muscle relaxation is a type of meditation where a person will focus on each part of their body, starting from their toes and going up to their head. During this exercise, the person will tense one muscle group at a time and then release the tension. Oftentimes, we don’t realize where we are holding tension in our bodies until we make ourselves release it.

When practicing this, one should focus only on one muscle group at a time and move slowly. Caregivers can go from their toes to their head or their head to their toes, as long as they include everything that is in between. They will tense their muscles on the inhale, pause for just a moment and then release the tension on the exhale. We should encourage caregivers to feel free to breathe out audibly, getting rid of anything they do not need.

Whether you practice progressive muscle relaxation, body scans, or journaling, you are living mindfully. We all have the ability to be mindful, we just need to give ourselves the space to practice it. We need to encourage our caregivers to take care of themselves by keeping up with their own physical and mental health to be able to better cope with stress and burnout. Introducing mindfulness is one way to address both.

What is mindfulness. Mindful. July 8, 2020. Accessed November 22, 2021. 

https://www.mindful.org/what-is-mindfulness/

National Alliance for Caregiving, National Cancer Institute and Cancer Support Community. 

Practicing mindfulness to relieve caregiver stress. Visiting Nurse Service of New York. Accessed November 22, 2021. 

https://www.vnsny.org/article/practicing-mindfulness-to-relieve-caregiver-stress/

Stoll, N. Three ways mindfulness can help caregivers

 Caring Across Generations. March 26, 2021. Accessed November 22, 2021. 

https://caringacross.org/blog-mindfulness-helps-caregivers/

Learning to relax. National Cancer Institute. March 23, 2021. Accessed November 22, 2021

https://www.cancer.gov/about-cancer/coping/feelings/relaxation

Articles

Within this intense experience, caregivers can often find themselves physically and emotionally exhausted

How Mindfulness Can Help Caregivers Cope with Stress and Burnout

For most institutions, the final date for being fully vaccinated for COVID-19 has passed or is quickly approaching—leaving some nurses feeling more pressure than ever.

Many had hopes of calling the bluff of their health care organization, but now are scrambling for a new career move. Although resistance to vaccinations has been around for 2 centuries, it has never been more politicized or debated following the COVID-19 pandemic. From freedom rallies to No. 1 hit songs, COVID-19 represents more than just widespread illness­—it is a socioeconomic torrent.

As nurses around the country weigh their professional options, some wonder if the answer resides in telling a white lie. But every choice has a consequence. What are the ramifications of lying on a religious exemption form?

These nurses are single moms and dads, breadwinners, 401K earners, and insurance providers. They need to work. A large number have survived the virus after caring for those who did not.

Feeling used and abused by hospitals and politicians, the temptation to fabricate a religious exemption is tempting. What's the big deal if there are suddenly more Dutch Reformed Congregationalists who don't believe in taking vaccinations?

 For starters, nurses are 1 of the most trusted professions in our country. And although we do not officially take the Hippocratic Oath, we abide by nonmaleficence (do no harm) and beneficence (do good) . Being deceptive may damage both of those principles.

Nurses have an innate desire to advocate for the ethical treatment of their patients, yet the foundation of continued employment could be established on deception. Having to choose a job over one’s honor is a cruel circumstance without a clear answer.

Due to burnout and stress, nurses have been leaving in droves even before the vaccine mandate. The thought of abandoning an already understaffed unit has many in our profession feeling guilty.

The hospital is often our home away from home—making the decision to conform or rebel more difficult. Many friendships are formed during each shift's long hours, and leaving behind these unique relationships is disheartening. However, there have been several reports of health care organizations approving nearly all religious exemption requests, and thereby staying tolerably staffed. This may be an appealing option for not only nurses, but hospital executives as well.

What about natural immunity? Do those nurses get a pass? The lack of conclusive data regarding the efficacy of antibodies produced by organic inoculation vs immunization has many nurses questioning the need for further viral protection.

Evidence-based practice is the backbone of the nursing profession, just ask our research instructors! Being told to forgo this fundamental learning objective is a hard pill to swallow (literally). Since medical experts can't even agree on the science of this subject, the nursing community is left feeling confused and leery. A bill was recently introduced to the House of Representatives called the "

," asking that natural immunity be considered when creating federal regulations. But as local politicians butt heads with the current administration, the bill will likely result in a long dragged-out ordeal. In the meantime, religious accommodation requests are at an all-time high.

To make matters even more complicated, we must consider the imperfections of the vaccine. Breakthrough cases of COVID-19 after full vaccination are being reported by local health departments daily. Unfortunately, many organizations are only subjecting non-vaccinated nurses to testing—leaving the potential for the vaccinated to spread the virus unknowingly. Many nurses fear that not only is this dangerous for patients, but this method will make anti-vaxxers appear solely responsible for being the disease spreaders. Perhaps the safest way to keep the virus out of the hospital is by testing every employee—leaving little room for error.

Either way, if COVID-19 can be contracted and spread whether vaccinated or not, what merit is there in removing great nurses from the workforce?

The predicament of fudging a religious exemption form goes deeper than just being dishonest. For many, it is their livelihood and freedom. So rather than incentivizing nurses to lie on exemption forms, perhaps we can provide COVID-19 testing for every health care worker to keep our patients surviving and our nurses thriving.

Vanderbilt Faculty & Staff Health and Wellness. Immunizations and religion. Accessed November 12, 2021. Available from: 

https://www.vumc.org/health-wellness/news-resource-articles/immunizations-and-religion

As nurses around the country weigh their professional options, some wonder if the answer resides in telling a white lie. But every choice has a consequence. What are the ramifications of lying on a religious exemption form?










Ramifications of Lying on a Religious Exemption Form for COVID-19 Vaccinations

Increasing burnout rates, vaccination mandates, and overall health care stress have some oncology nurses looking for a change. Switching from hospital to hospital doesn’t usually improve symptoms of being overworked, and going back to school can be expensive and time-consuming. However, becoming a nurse entrepreneur can be a surprisingly easy and sometimes affordable option that most nurses never consider.

Nothing beats working autonomously while providing excellent patient care on your terms! As a business owner, I know firsthand that getting started can be fun if you have the right tools. So, here are 3 easy and inexpensive ways you can become a nurse entrepreneur, too.

Before diving into the details, you may be wondering what type of businesses registered nurses (RNs) or nurse practitioners (NPs) can own. Here are a few new and exciting ideas:

IV hydration clinics (RNs and NPs): This quickly expanding market offers IV replenishment for post-op recovery support, as well as for immunity boosters and performance formulas.

Concierge nursing (RNs and NPs): This business allows RNs to deliver elite care in the home-based care of the patient’s individual needs and requests.

Integrative health (RNs and NPs): Integrative health services practice holistic care through activities like mindfulness, acupuncture, and herbal remedies.

Chronic care management (RNs and NPs): The 2015 change in chronic care management for Medicare patients makes this an attractive practice for many nurses.

Health writing (RNs and NPs): As the need for credible online content increases, so do 

Health and wellness coaching (RNs and NPs): Working directly with patients endorsing health, providing general support, and helping develop empowerment.

Med spa (RNs and NPs): Providing non-surgical procedures to improve skin and body health.

Retail medical clinics (NPs). Found in grocery stores, pharmacies, and retail stores, NPs provide acute care keeping people out of emergency departments.

Keep in mind that the state you live in plays a significant role in your scope of practice. Sometimes, physician oversight is required–but don’t let that scare you away. Many physicians love helping nurse-led health care practices, especially if they can earn a few bucks as well. In addition, some agencies provide medical directors for nurse-owned businesses at an affordable price.

Here are ways you can get started on the rewarding path to entrepreneurialism.

You would be amazed by all the free resources found on the internet. I stumbled across health writing after viewing a Facebook ad. After much investigating (reading reviews and social media following), I found a trustworthy company and got to work. Reading newsletters, blogs, and watching Youtube videos are easy ways to acquire more knowledge on a potential business idea. Subscribing to free masterclasses and online courses provides a wealth of helpful information as well. Once you’re fully committed to pursuing your new career, affordable memberships offer step-by-step guidelines to being a successful business owner. Up to that point, however, you don’t have to spend a dime. You will also need to contact your local government to discuss the rules and regulations of business ownership in your county/state.

Reaching out to other nurse entrepreneurs for support is crucial for business startups. Finding a safe community to share successes and bounce ideas off of one another decreases anxiety and provides motivation. Networking with like-minded nurse entrepreneurs is accessible with platforms such as LinkedIn. I suggest creating a profile and searching for people within your workspace. Learning tricks of the trade from those further along the entrepreneurial journey provides valuable advice and learning opportunities. These connections may be free of charge but worth more than money can provide!

The road to becoming a nurse entrepreneur can be lonely and often tests your confidence. Success can be slow to come, leaving you wondering if you chose the right path. Mistakes and bumps in the road can lead to self-doubt and feelings of inadequacy. Despite it all, however, you must be persistent and persevere. It’s ok to take a break and re-group, but you must keep moving forward. Samuel Johnson said, “Great works are performed not by strength, but by perseverance.” Although I am a novice business owner, I am proof that grit pays off–check out the byline for this article!

We became nurses to heal, soothe, and support the sick. But, who says nursing can only be done in a hospital? The landscape of health care is changing quickly, leading to opportunities for nurses to run their own businesses. Nurses can provide the autonomy and knowledge required to deliver outstanding patient care in unique and creative ways. You could be 3 easy and inexpensive steps away from your dream job. Go for it!

Becoming a nurse entrepreneur can be a surprisingly easy and sometimes affordable option that most nurses never consider.

Three Easy and Inexpensive Steps to Becoming a Nurse Entrepreneur

It’s interesting how oncology nurses can have two patients with the same diagnosis, prognosis, and treatment, but with entirely different outcomes. Although each patient may be cured, why will one easily tolerate cancer treatment while the other struggles every step of the way?

Mindset is often an overlooked aspect of the experience, but it is perhaps the most essential quality. Integrative remedies such as massage, aromatherapy, and acupuncture have become commonplace treatments at most cancer centers nationwide. However, there are some other unique methods oncology nurses that can use to help patients ‘

’ their way to well-being during cancer treatment.

I recently realized that for the past 12 years, I may have been teaching visual imagery wrong. Having patients imagine their tumors shrinking while chemotherapy attacks cancer cells could be doing more harm than good, and here’s why. If we consider the belief that positive thoughts bring positive results while negative thoughts bring negative results, asking patients to visualize cancer in their bodies could be a disadvantage.

Overlooking one’s disease may sound counterintuitive, but having patients focus on the healthy aspects of their bodies could be a far better approach. So, rather than encouraging patients to acknowledge their sickness, it’s more valuable to have them recognize their wellness. Replacing words like ‘kill’, ‘attack,’ ‘fight,’ or ‘win’ with terms like ‘healthy,’ ‘strong,’ ‘healing,’ and ‘clarity’ fosters an environment of grace and empowerment. There are also visual meditation techniques that may lead to enhanced immune responses and an improved positive mindset. Honoring each cell’s innate ability to heal through optimistic imagination is an effective way for patients to 

themselves as the healthy beings they are.

Another approach to helping patients stay focused on well-being is to encourage the ‘practice of appreciation’ through daily journaling. Studies show that giving thanks

 leads to more happiness and pleasure. Why appreciation and not gratitude? Often, gratitude evokes feelings of scarcity or lack because being grateful can mean there was a struggle to overcome.In comparison, having appreciation comes from a neutral place of pure love and acceptance. Gratitude conjures feelings of effort and work while appreciation represents ease and contentment. It is important for the patient to focus on comfort rather than hardship.

Because it can be challenging to maintain appreciation during the cancer journey, starting small is helpful. For example, being thankful for a soft pillow, a comfortable couch, a great view from the bedroom, or the warmth of a pet are simple ways to express appreciation. Encourage patients to keep cancer out of this journal! Only give attention to things that feel good and bring joy. If a patient wakes up without nausea, have them write about how good a particular food may taste or smell. If they have the energy to walk around the block, encourage them to journal about how lovely the sun felt or how uplifting the fresh air was.

The physical act of writing keeps people in a place of thankfulness longer because more time is spent concentrating on words, grammar, and spelling. In addition, when feeling blue, reading previous entries can be uplifting. It takes practice, but these small visual shifts can improve resilience and attract more health and wellness.

It may sound absurd to promote a ‘giving’ attitude when patients are spending much of their time healing. However, acts of kindness

 are known to release hormones that improve mood and happiness. For example, dopamine, serotonin, and oxytocin are known as ‘feel good’ chemicals that lower blood pressure, reduce pain, and produce a sense of euphoria. Since these chemical reactions only last for several minutes, repeating acts of kindness throughout the day is a great way to maintain gratification.

I’m not suggesting that patients with cancer volunteer hours of their time or run marathons to raise money, but I am suggesting that they consider sending flowers to a friend or mailing love letters to those they adore. These little acts can help provide relief from negative thoughts or worry. Not only is there a “helpers-high” by offering acts of kindness, but there is also delight in watching someone receive an unexpected gift of love.

Oncology nurses are more than managers of disease. They are also promoters of health. Although we ensure that our patients are equipped with the tools they need to survive cancer, we also need to inspire them to thrive with cancer. In the words of Sadhuguru, “Health is not just being disease-free. Health is when every cell in your body is bouncing with joy.” By teaching our patients how to ‘see’ their way to well-being, we get to watch courage and hope turn into joy.

Harvard Health Publishing. Giving thanks can make you happier. August 14, 2021. Accessed October 21, 2021. 

https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier

Cedars Sinai. The Science of Kindness. February 13, 2019. Accessed October 21, 2021. 

https://www.cedars-sinai.org/blog/science-of-kindness.html

Rather than encouraging patients to acknowledge their sickness, it’s more valuable to have them recognize their wellness.

Unique Methods Help Patients ‘See’ Their Way to Well-Being During Cancer Treatment

She walked into the room radiating with excitement and nervousness. I stood next to her wearing my lab coat with a fancy name badge pinned to the collar, also eager for the day. I watched as the night nurses, donned in blue scrubs, prepared to give report to the next shift. I also noticed that not a single greeting was offered our way; there was an evident aversion towards us. It was as if our existence would be confirmed should eye contact be made, our invisibility cloak removed with a simple hello.

As I observed the awkward avoidance, I could feel my blood pressure begin to rise. “How long will they pretend we aren’t here?” I wondered. Several minutes after report was given, the shunning was finally shattered with the following greeting - “We aren’t that busy, so I’m not sure what to do with you; go sit over there until we figure it out.” My cheeks flushed with anger and I felt like a mama bear ready to protect her young. I turned and looked at my student. She was dressed in perfectly ironed white scrubs, notebook in hand, and still smiling. Aware of my indignation, she whispered, “It’s ok, this happens to us all the time; I’ll be alright.” Then she obediently walked to her appointed seat where she would remain–out of sight –until invited to participate.

I recently retired from a local hospital after 25 years of employment and decided to take the next natural step and become a clinical nursing instructor. When I worked in the hospital, nurses were known to “eat their young,” meaning nursing students or new nurses were treated with hostility. Full-blown snubbing seems to have been added to that ageless practice. In a recent rotation, I was even pulled into an empty room by a nurse who wanted to gossip about ‘how terrible nursing students are these days.’ My students gave me an equally negative appraisal of that nurse.

Perhaps I’ve become naïve to the hospital culture, coming from a lovely outpatient oncology clinic, or maybe nurses are just that tired and burned out. Don’t get me wrong; I would be lying if I didn’t admit that one perk to working in the summers is having a break from students, but I could never deliberately ignore a human being’s existence. Sadly, in my short time as an instructor, I’ve been both embarrassed and discouraged by my peers and colleagues. What has happened to America’s sweethearts?

Unfortunately, the pandemic resulted in many nursing students being banned from clinical sites. Beyond a few outpatient clinics, many have had to rely on simulation and virtual simulation to meet their required clinical hours. These future healthcare heroes need comprehensive hands-on clinical instruction more than ever! Giving them grace while they navigate caring for real-life patients is essential to their professional growth. One study suggests that positive clinical engagement fosters the desire for “deep learning.”

 Although more research is needed to better understand how clinical engagement can be enhanced, we can certainly agree that giving nursing students the cold shoulder does not make for an informative or constructive educational experience.

I love a great underdog story, and nursing students are today’s come-back kids! In post-clinical a few weeks ago, my students shared stories of needing to chase nurses around who barely spoke to them or being plopped in front of computers down the hall from where their preceptors mingled. One student pointedly asked, “Shouldn’t they want us to graduate and come back here to work? They are so understaffed it seems like they need us.” I couldn’t have said it better myself.

According to a survey analysis published in 

 in 2018, approximately 31.5% of nurses who leave their jobs do so due to burnout.

 But help is on the way, and just because they are in white scrubs today doesn’t mean they won’t be carrying your life preserver tomorrow! Teaching nursing students everything you know now will preparethem to keep the ship from sinking once they graduate.

Jenny Han said, “Victory is a thousand times sweeter when you’re the underdog,” so to every nursing student – hang in there, victory will soon be yours!

Alas, the beast exists, but its yang is always nearby, found in most nurse preceptors' bright eyes and warm smiles. I saved the beauties for last because they are worth remembering.

To all the nurse preceptors who take the time to engage with the students: You are the best kind of memory. Your name comes up often in class because students hope you will be their mentor for the day. They say things like “s/he is the type of nurse I want to be.” You renew their passion for our profession.

They know you are tired, yet have the patience to teach, because you recognize they 

the future. They know you are busy, yet educate on-the-go, because you understand they will be your co-workers. They know you have personal stress, yet share your tricks of the trade, because you realize they will be caring for your family one day. They know, and they are thankful.

Nursing students are mere buds of the nurses they will become. Nurse preceptors can be the drought that stunts their growth, or they can be the warmth that encourages them to bloom. It takes a village to raise outstanding nurses, so next time you are given the opportunity to shun or shine, we hope you choose to bask with the beauties.

Ghasemi MR, Moonaghi HK, Heydari A. Strategies for sustaining and enhancing nursing students' engagement in academic and clinical settings: a narrative review. 

. 2020;32(2):103-117. doi:10.3946/kjme.2020.159

Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and Factors Associated With Nurse Burnout in the US. 

 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469

Nursing students sometimes face surprising hostility from nurse preceptors, explains contributor, Serenity Mirabito. However, the best nurse preceptors operate as agents for good by training and fostering the enthusiasm of young nursing students.

Beauty and the Beast: The Two Faces of Nurse Preceptors

Last week, a patient asked me to be removed from their care team for not disclosing my COVID-19 vaccination status and shocked does not begin to accurately describe my reaction. As an expert oncology nurse with more than 2 decades of service under my belt (or scrubs), I have never had a patient ask me about my medical history. I was so taken aback that I found myself stumbling over my words. After finally spitting out an awful, unrehearsed retort about policies and personal rights, she informed me that she was not comfortable under my care. I gasped in disbelief. “I am a great nurse, and my patients love me!”, I wanted to reply, but I simply apologized and honored her wishes. Then, I began to ponder the need for professional privacy.

Despite where someone stands on the COVID-19 vaccine debate, it is hard to deny that it is awkward when a patient asks, "are you vaccinated?". Of course, as vaccine mandates nip at the heels of every healthcare provider, answering "yes" to this seemingly intrusive question may be the only acceptable answer. In the meantime, however, it is crucial for nurses to keep their medical choices private and to politely tell patients to mind their own business.

Although I understand their reasoning, I cringe every time I hear a nurse use HIPAA to protest being asked about their vaccination record. It is not a HIPAA violation for patients to ask their healthcare provider if they have been vaccinated against COVID-19.

This federal law protects privacy by defining 

 health information is protected, but it does not restrict patients from asking their nurse (doctor, medical assistant, phlebotomist, etc.) about their medical history.

However, health care providers are not required to answer any questions about our health choices, nor should we. It's that simple.

Not so straightforward, admittedly, is whether organizations can legally adorn their employees with badges and stickers that exploit their vaccination choice. The answer should be a solid no, but it's more like "no-ish". According to the Equal Employment Opportunity Commission (EEOC), vaccination status is considered confidential.

 So, although being forced to bear the scarlet letters “vaccinated” or “unvaccinated” on your scrub top is unlawful, we may be required to have an indiscreet sticker placed on our badge or wear a wristband that affirms our compliance with hospital policy.Why do we need visible evidence of our conformity? Hospital administrators explain that it allows for quick and clear assurance that staff is following safety rules. For example, if an associate is not wearing a mask, a nonchalant glance at the required "accessory" confirms their immunization status, and the proper steps can ensue.

Although there is value in this approach, I wonder about the ramifications for staff who do not yield the sign of obedience. Will judgement occur once patients catch on to the purpose of a covertly placed sticker? Backlash by coworkers has already been reported by nurses who do not want the vaccine. Even more troublesome could be the voluntary bearing of pins that exclaim in all capitals “I’M VACCINATED!”. As if healthcare workers weren’t under enough pressure, we now must compete with one another in garnishments that seem to establish two separate sides, the uncompliant anti-vaxxers versus the selfless vaccinated conformers. Why can’t simply being employed provide enough proof that we are following our institution’s policies, therefore, providing safe medical care? 

Although it is uncomfortable to have our personal medical decisions scrutinized by patients, we must remind ourselves to understand their intentions. Patients are not asking these questions to be nosy or rude but rather to feel safe under our care. Yet, now, more than ever, political views are influencing people’s medical decision making - creating a slippery slope for nurses to navigate.

Therefore, after much rehearsal, here is my new spiel if asked about my vaccine status (you’re welcome to use it as well) - "Mr. Smith, although my medical history is between my care provider and me, I understand that you want to feel safe today (tonight), so I assure you that I follow my organization's policies for COVID-19 safety and that you are in trusted hands.", then I will quickly place my stethoscope in my ears!

Even if you are proud of being vaccinated, I urge you to set clear precedence for privacy with patients, and here's why.

We already share so much with those we serve: our time, energy, healing, and devotion. So, whether you are in line to get the vaccine or in a rally to protest it, nurses should stand together to protect our privacy by maintaining professional boundaries with patients. An unknown author wrote, "I set boundaries not to offend you but to respect myself." Today's inquiry may be about our vaccination status, but tomorrow’s question could involve our mental health history, finances, or social status. The list goes on.

Therefore, in addition to politely telling our patients to mind their own business, it is crucial to strip ourselves of the decorative adornments that give clues to our personal health choices. By drawing a clear line now, maybe we can prevent crossing it in the future.

Is it a HIPPA violation to ask for proof of vaccine status? HIPPA Journal. May 25, 2021. Accessed September 29, 2021. 

https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/

What you should know about COVID-19 and ADA rehabilitation act and other EEO laws. U.S. Equal Employment Opportunity Commission. Updated May 28, 2021. Accessed September 29, 2021. 

https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws

An oncology nurse with over 20 years of experience ponders the necessity of professional privacy in the workplace -particularly in light of COVID-19 vaccinations. 

Opinion: Nurses Need to Stop Disclosing Their Vaccination Status to Patients 

Particularly for women, breast cancer remains the highest cancer with an estimated 281,550 new cases in 2021 alone. While the survival rates for breast cancer have overall improved due to advancements in treatment and clinical trials, Black, Indigenous, People of Color (BIPOC) still represent the population with the highest death rates among all demographics.

BIPOC patients diagnosed with breast cancer often face additional barriers–like health disparities, health literacy, and lack of knowledge of the psychosocial effects–in comparison to other ethnic groups. Such barriers are not often addressed in a medical setting, which can contribute to BIPOC’s mortality rate and poorer outcomes.

Not only do BIPOC have a higher mortality rate in comparison to their White counterparts, they are also more likely to be diagnosed at a younger age, and at a more advanced and/or aggressive stage. There are many reasons for this.

One factor is due to the lack of access to resources, which can prevent BIPOC individuals from having their cancer detected early, receiving quality care, or experiencing a delay in their treatment. BIPOC’s limited access to care is common within low income, predominantly BIPOC neighborhoods as well.

Furthermore, it has been documented BIPOC are not effectively represented in studies in various treatment options for breast cancer, especially in clinical trials. This is essential as the genetic makeup of tumors in BIPOC can differ in comparison to other ethnicities, including triple-negative breast cancer.

So, while advancements in treatment among the White population have shown to be successful, less is known about how the same or similar treatments would positively impact BIPOC, including whether other remedies are needed.

Difficulties with understanding cancer treatment and medical terms are common among all patients with cancer. However, it is even more evident among BIPOC due to various social-economic factors, such as educational background. Specifically, with patients with breast cancer, BIPOC reported they received limited information about their treatment side effects, including infertility.

BIPOC patients further expressed not feeling comfortable asking questions with their medical team as they are answered in terms they do not comprehend. Lack of clear communication can additionally make BIPOC distrustful of their medical teams, which then results in them seeking information that might be inappropriate or incorrect elsewhere. Additionally, patients who feel they do comprehend their treatment can feel overwhelmed, and then are not able to make informed decisions.

Lastly, BIPOC patients are often not educated on alternative treatment options including clinical trials. As a consequence, BIPOC may be resistant to medication/treatment compliance or lack the willingness to participate in studies that can assist with advancements in treatments among the BIPOC community.

People diagnosed with breast cancer experience similar psychosocial effects as others with cancer, including depression and anxiety. However, in the BIPOC population, such effects are often ignored.

In a study conducted by Lewis et al, they found that BIPOC’s depression are “often under-recognized and under-treated.” They further noted how such acknowledgements would make an impact in a BIPOC’s cancer journey and quality of life.

Such studies highlight the lack of emotional support services BIPOC receive during their treatment, including providing them with the tools to help them navigate through their cancer experience. Often, there are misconceptions about how BIPOC cope with cancer. This can impact how BIPOC patients cope with their diagnosis, including limiting their access to resources such as counseling or support groups, and their willingness to participate with follow-up after treatments.

If BIPOC patients find their cancer experience traumatic, it may make them reluctant to engage in follow-up, which is significant to prevent and minimize a reoccurrence.

There are ways medical professionals can begin to help BIPOC patients with breast cancer navigate through their cancer journey as well as cope with the challenges they endure:

Listen: It makes a difference when BIPOC feel they are being heard and validated by their medical team. There are numerous stories within the BIPOC communities of how often providers dismissed their feelings when they expressed their concerns, especially feelings such as hopelessness depression or their experience with side effects.

Educate: Providing an environment for open-ended questioning and not rushing a patient during appointment can help a BIPOC develop an overall better understanding of their diagnosis and their options. They are then able to make a more educated and informed decision.

Understanding Certain Stereotypes:Sadly, there are stereotypes against BIPOC women that affect their care. These include being seen as very “strong “or “angry/aggressive.” Many do not understand how BIPOC’s appearance of strength or anger are rooted in having to adapt often to various struggles and disparities throughout the course of their lives. This appearance, sadly masks vulnerable feelings that providers fail to address. Be mindful when using certain words including telling a patient they are strong or brave. While such statements are intended to inspire hope, they can also dismiss someone’s feelings of depression. It is important to provide a place where patients feel comfortable with admitting they need help or support. There is a useful workshop series from Living Beyond Breast Cancer, which has some insight to BIPOC’s struggles with breast cancer for reference.

Familiarize yourself with available resources:This would include databases for clinical trials and psychosocial support such as support groups and counseling services as well as encouraging patients to utilize them. Also, be mindful not to immediately push them to see a social worker or financial navigator. Validate their feelings and hear their concerns to direct them to the appropriate resources.Some resources for support include CancerCare, Triple Negative Breast Cancer Foundation, Black Cancer, Touch, The Black Breast Cancer Alliance, and Susan G Komen Foundation.

The more people who are aware of BIPOC’s struggles with breast cancer, the more their barriers can be addressed. Decreasing such barriers can make a significant difference to increase the survival rates for BIPOC with breast cancer.

1. Cancer stat facts: cancer disparities. National Cancer Institute Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/disparities.html

2. Health Equity Initiative. https://www.komen.org/about-komen/our-impact/breast-cancer/health-equities-initiative/

3. Yedjou, Clement G et al. “Health and Racial Disparity in Breast Cancer.” Advances in experimental medicine and biology vol. 1152 (2019): 31-49. doi:10.1007/978-3-030-20301-6_3

4.Lewis, Pamela E et al. “Psychosocial concerns of young African American breast cancer survivors.” Journal of psychosocial oncology vol. 30,2 (2012): 168-84. doi:10.1080/07347332.2011.651259

5.Rust, Connie, and Cindy Davis. “Health Literacy and Medication Adherence in Underserved African-American Breast Cancer Survivors: A Qualitative Study.” Social work in health care 50.9 (2011): 739–761. Web.

6.Sheppard, Vanessa B et al. “Correlates of depressive symptomatology in African-American breast cancer patients.” Journal of cancer survivorship : research and practice vol. 7,3 (2013): 292-9. doi:10.1007/s11764-013-0273-y

BIPOC patients diagnosed with breast cancer often face additional barriers–like health disparities, health literacy, and lack of knowledge of the psychosocial effects–in comparison to other ethnic groups.

Barriers in BIPOC Populations Diagnosed With Breast Cancer

Carolyn Hayes, PhD, RN, NEA-BC, chief nursing officer for Oncology Services at RWJBarnabas Health and Rutgers Cancer Institute of New Jersey, has been selected by the American Academy of Nursing (AAN) as a 2021 Fellow. Induction into the Academy is a significant milestone in a nurse leader’s career in which their accomplishments are honored by their colleagues within and outside the profession. Fellows are selected based on their contributions and impact to advance the public’s health.

The AAN is an honorific society that recognizes nursing's most accomplished leaders in policy, research, practice, administration, and academia. Academy Fellows, from nearly 40 countries, hold a wide variety of roles influencing health care. Fellows contribute their collective expertise to the Academy, engaging with health leaders nationally and globally to improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science.

Dr. Hayes has experience in ensuring the continuity of care across the ambulatory and acute care continuum for oncology patients in unique collaborative settings, including those that bring together a National Cancer Institute-designated Comprehensive Cancer Center and large health care system in an academic setting. As a nursing leader, Hayes is responsible for and has oversight of nursing at Rutgers Cancer Institute and oncology service line-related nursing across RWJBarnabas Health, ensuring nursing excellence throughout an integrated cancer care model.

“Induction into the American Academy of nursing as a Fellow is more than just recognition of one's accomplishments within the nursing profession,” notes RWJBarnabas Health Executive Vice President and Chief Nursing Officer 

. “It represents the strength of the nursing and health delivery system, shaping healthy environments and enhancing the quality of patients’ lives, all of which Dr. Hayes exemplifies in her work at RWJBarnabas Health and Rutgers Cancer Institute.”

“Through her nursing leadership, Dr. Hayes has been instrumental in enhancing the role of Rutgers Cancer Institute of New Jersey and RWJBarnabas Health as a leading oncology authority in our region,” shares Rutgers Cancer Institute Director 

, who is also senior vice president of oncology services for RWJBarnabas Health. “We congratulate Dr. Hayes for achieving this great honor and look forward to her continued success in the development and management of comprehensive patient care, research and teaching.”

“I am pleased and excited that Dr. Hayes is being recognized by the American Academy of Nursing in this way,” said 

, professor and dean of Rutgers School of Nursing. Among seven New Jersey-based nurses elected to this highly prestigious organization this year, our Rutgers-affiliated colleagues including Dr. Hayes truly exemplify our school's motto ‘Excellence in Action.’”

“Becoming a Fellow in the American Academy of Nursing is a great honor for me and signifies that my work at RWJBarnabas Health and Rutgers Cancer Institute will have impact on the profession of nursing and the nation’s health,” notes Hayes, who also holds a faculty appointment as an associate professor in the Division of Nursing Science at Rutgers School of Nursing. “As a new fellow of the AAN, I look forward to working with nurse leaders across the world to enhance the quality of nursing practice, research, education and impact on health care.”

Prior to joining Rutgers in 2019, her leadership included co-founding and serving as president and executive director of the Greater Boston Nursing Collective and associate chief nurse for Oncology, Medical and Integrative Nursing at Brigham & Women’s Hospital and Dana-Farber Cancer Institute in Boston. Her clinical and leadership practice, teaching, research, and publications have been focused on integrative nursing, clinical ethics, leadership, and end-of-life nursing care.

Inductees will be recognized for their significant contributions to health and health care at the Academy’s annual Health Policy Conference, taking place on October 7 through 9. This year’s conference and induction ceremony will be offered in a hybrid format, allowing attendees to participate either in-person or virtually.

This article was originally posted on RWJBarnabas Health as 

"RWJBarnabas Health and Rutgers Cancer Institute of New Jersey Leader Selected to be Inducted as a Fellow of the American Academy of Nursing"

 Carolyn Hayes, PhD, RN, NEA-BC, chief nursing officer for Oncology Services at RWJBarnabas Health and Rutgers Cancer Institute of New Jersey, has been selected by the American Academy of Nursing (AAN) as a 2021 Fellow

Rutgers Chief Nursing Officer Selected to be American Academy of Nursing Fellow

Cancer patients face many obstacles to care, including financial, psychosocial, and practical barriers. Health disparities also prevent patients from receiving optimal treatment. In order to be an effective case manager, health care professionals must have a clear understanding of the definition of this role, the overall benefits of case management, and how to assess patients’ needs. The priority must be to put the patient first in order to improve outcomes. Addressing inequities in access to care is essential to adequately enhance a patient’s wellbeing.

Case Management Within Professional Practice

According to the Commission for Case Manager Certification, case management is a "collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes."

Nurses, social workers, and other professionals are including case management in their role with patients in order to provide efficient service. Regardless of professional background, case managers use a patient-centered and strengths-based approach. Effective engagement puts the patients’ needs first and identifies the most beneficial resources available.

Professional case managers take on many responsibilities in their pursuit of improving patient outcomes. They take the patients’ beliefs, interests and values into consideration, while evaluating how to best support their desired goals. After conducting a needs assessment, case managers will determine how to best serve the patient. Planning and implementation stages are crucial in moving forward with completing and evaluating achievements.

Additionally, advocating for patients is at the forefront of case management, and is included in every component of the case manager’s intervention. Case managers have the ability to foster relationships with patients, while providing resources that best meet their needs. Patients may have complex circumstances, and this warrants a more comprehensive approach to address the whole person.

Overall, interventions have a positive impact on cancer patients and gives them the tools they need to overcome challenges and improve outcomes.

 When considering financial burdens, for example, patients often report that including case management services was successful in easing anxiety related to costs.

Case management improves patient quality of life

and increases empowerment and self-efficacy.

 Cancer patients may face stressors that negatively impact their psychosocial, financial, physical or social functioning. These risks are even greater if a patient is isolated and without support. These effects can be overwhelming and long term. Including case management helps patients return to prior levels of functioning.

Health inequities are examples of other barriers that can adversely effect a cancer patient’s experience. Case managers must make it their priority to address these heath care disparities. This is accomplished by developing methods to either eliminate or minimize the impact they have on their health care.

Case managers can promote policies that support equality, fight for patients’ rights and facilitate communication to be a strong advocate.

All health care professionals must demonstrate a culturally competent and inclusive practice to effectively address disparities. This can be done through the creation of a safe environment, free of judgment and oppression. We play a critical role in reducing inequalities and overcoming barriers to care for all people regardless of race, ethnicity, age, socioeconomic status, ability, gender identity or sexual orientation. Case managers strive to support all efforts to advocate for cancer patients and find resources that are culturally and linguistically appropriate.

A well-rounded approach to case management in cancer care will ultimately benefit the patient in a variety of ways. An experienced case manager includes strategies to address barriers and disparities in all aspects of their work. Incorporating these skills will promote better coordination of care and access to resources, while improving the patient’s ability to cope with cancer. With these objectives in mind, case management will continue to have a significant role in meeting the needs of patients.

 is Director of Specialized Programs at Cancer

 is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include case management, counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All Cancer

 services are provided by master’s-prepared oncology social workers and 

Commission for Case Manager Certification. 

Definition and Philosophy of Case Management 

https://ccmcertification.org/about-ccmc/about-case-management/definition-and-philosophy-case-management

2. Harkey J. Case management at the intersection of social work and health care. 

3. Scherz N, Bachmann-Mettler I, Chmiel C, et al. Case management to increase quality of life after cancer treatment: a randomized controlled trial. 

. 2017:17(1):223. doi:10.1186/s12885-017-3213-9

4. Yin YN, Wang Y, Jiang NJ, Long DR. Can case management improve cancer patients quality of life?: A systematic review following PRISMA. 

. 2020;99(40):e22448. doi:10.1097/MD.0000000000022448

5. Wu C, Bannister W, Schumacker, P, Rosen, M, Ozminkowski, R, Rossof A. Economic value of a cancer case management program. 

 2014: 10(3): 178-186. doi: 10.1200/JOP.2014.001384

Case managers can ease health inequities and barriers to care.

https://www.reliasmedia.com/articles/144745-case-managers-can-ease-health-inequities-and-barriers-to-care

In order to meet the multifaceted needs of cancer patients, the role of case management in cancer care has recently grown.

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