Cathy is 76 years old and has been living with metastatic breast cancer for more than 7 years. Her home is 240 miles from her oncology center. Although she has relied on her adult daughter and friends to accompany her to appointments, as her disease has progressed, Cathy has had difficulty finding help with travel.

Cathy has enrolled in a phase I clinical trial, which requires more frequent trips to her oncology center for treatment. She does not have the resources to pay for a hotel. When asked about her ability to drive after treatments, she says sometimes severe fatigue causes her to pull off the road and sleep for a few hours. However, she is adamant that she is a safe driver. The oncology nurse notes that her current medication list includes oxycodone (Oxycontin), bupropion (Wellbutrin), lorazepam (Ativan), pregabalin (Lyrica), and zolpidem (Ambien).

Although the above scenario may seem extreme, nurses are often faced with similar situations when caring for their patients. What constitutes a high-risk driver? When should a patient be advised to stop driving? And how should oncology nurses approach patients and families about this sensitive issue?

Motor vehicle injuries persist as the secondleading cause of injury-related deaths in individuals over the age of 25.

 Traffic safety programs have had some success in reducing crash rates for all drivers, but the fatality rate for drivers over 65 has remained high. Unfortunately, there are no official guidelines for when to advise patients to stop driving.

Oncology nurses are in a unique position to address this problem. The conversation may be initiated by a concerned caregiver. Asking permission to speak with caregivers for additional information is important. This is a sensitive issue, so approach this discussion with empathy and compassion. Take the time to listen to the concerns of your patients and their caregivers, and help them identify realistic, safe goals. Exercise sensitivity when asking patients about how they perceive their driving habits, as they will almost always downplay any problems for fear of losing their license.

Clinical risk factors that may indicate impaired driving include decreased physical and cognitive abilities. Simple questions to screen for impairment include:

• Do you drive to the grocery store or the bank or for other day-to-day errands?

• Is your vision affected when you drive at night?

• Has anyone ever expressed concern that you may not be as safe on the road as you once were?

• Have you been involved in any accidents within the past 6 months?

Patients must understand that their safety comes first. The following are signs of a potential safety risk:

• Difficulty with remembering the difference between the gas and brake pedals

• Inability to maintain a consistent speed

• Following too closely and/or driving too slowly, which may indicate a difficulty with perception

• Not providing appropriate turn signals

• Delayed response to unexpected situations

• Minor accidents causing scrapes and dents and/or multiple fender benders

Engaging other team members in the discussion can be helpful. In some states, physicians are required to report to the Department of Motor Vehicles (DMV) patients who may be considered at risk. Physicians can often initiate the conversation with the patient, and social workers are also important resources for helping to explore alternative means of transportation.

Pharmacists can help review medication history and use of OTC drugs and anticipate drug-drug interactions. Medication classes that may impair a patient’s driving ability include anticholinergics, anticonvulsants, antidepressants, antiemetics, antihistamines, antihypertensives, antiparkinsonians, antipsychotics, benzodiazepines, muscle relaxants, narcotic analgestics, and stimulants.

IS IT IMPORTANT FOR NURSES TO REPORT AT-RISK DRIVERS?

All states have their own DMVs, so the rules vary across the country. Recommending that a patient’s license be revoked for medical reasons can often entail a difficult and time-consuming process. The physician—nurse relationship is important for ensuring that you are working as part of the team and not in isolation. In addition, DMV.org is an excellent resource for patients and families who are trying to determine driver safety.

When a safety risk is identified and a patient is deemed unable to drive, families must set up an alternative means of transportation. Uber, taxis, and friends are possible solutions. As part of the American Cancer Society’s Road to Recovery Program, volunteers donate their spare time to offering rides for patients with cancer. In addition, some communities have churches, local nonprofits, and senior centers that can assist with transportation.

If a patient’s license is revoked, nurses should discuss with caregivers and family members the impact this can have on the patient’s quality of life. Limitations on socializing with others can lead to depression, for instance. 

Caregivers need to be aware of this potential and stay in close contact with the patient’s primary care provider as well as other identified support staff. This can include a chaplain and a psychologist.

In Cathy’s case, we reached out to our social worker. A family conference was facilitated with the patient and her daughter so we could share our concerns about Cathy’s safety. Once her daughter recognized the seriousness of the situation, she made an effort to accompany her mother to all future appointments. We were able to help Cathy identify nearby affordable housing so she could avoid having to travel far on the days when treatment was long, as well as additional travel resources in her own community that she was unaware of. We feel that we achieved our goal of ensuring her safety but realize the ongoing support that will be required to ensure Cathy is still maintaining an acceptable quality of life.

1. Centers for Disease Control and Prevention. 10 leading causes of injury deaths by age group highlighting unintentional injury deaths, United States — 2017. cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_unintentional_2017_1100w850h.jpg.

2. AARP. We need to talk: the difficult driving conversation. 2016. aarp.org/auto/driver-safety/info-2016/when-to-stop-driving-in-older-age.html

3. Chihuri S, Mielenz TJ, DiMaggio CJ, et al. Driving cessation and health outcomes in older adults. J Am Geriatr Soc. 2016;64(2):332-341. doi: 10.1111/jgs.13931.

Articles

Professionally Speaking

How should oncology nurses navigate this sensitive discussion with patients and their families?

Should Your Patient Be Driving?

Smilow Cancer Hospital, a large academic, National Cancer Institute—designated center with 10 community locations in Connecticut, has a standardized, centralized process for oral chemotherapy prescription management to ensure safe administration to patients. Despite the organized process, patient feedback revealed delays between the time a prescription is ordered and the time it is dispensed. Patients’ anxiety due to their lack of understanding and knowledge of the process caused an increase in call volume among the patients, the pharmacy team, and providers.

Patients had questions about medication supply, insurance coverage, and safe handling, as well as other general concerns. Because delays and patient confusion can cause loss of adherence and a poor patient experience, the hospital created a communication tool to explain the process clearly.

Smilow Cancer Hospital compiled qualitative and quantitative information from practice and infusion nurses about call volume and the types of calls received regarding oral chemotherapy prescriptions. The context of many of the calls was the same: Patients had a lack of awareness about when they would receive their prescriptions, why they could not get them immediately, and the extreme importance of maintaining the treatment schedule.

Under the hospital’s oral chemotherapy prescription process, the physician first follows a therapy plan and electronically orders the medication. The order triggers the Smilow pharmacy team to review the prescription for safety and appropriateness. The prescription is then sent to the most appropriate filling pharmacy or mailorder company, and coverage, along with any possible medication assistance, is determined. Patients are often unaware of how many steps go into this multistep, interdisciplinary approach. Unit leadership provided input, and the institutional policy on the oral chemotherapy ordering process was reviewed. The pharmacy team was consulted to discuss workflow and how they handle patient follow-up to identify potential gaps in communication and opportunities for improvement.

The Smilow Cancer Hospital developed a patient communication tool to standardize the education provided to patients and to clarify their expectations regarding the procurement process. Additionally, information on whom to call and when to call about prescription concerns and new or worsening side effects, along with safe handling instructions, was incorporated, all in a 5-by-7-inch, 2-sided take-home document.

The tool is easy to distribute and provides patients a simplified picture of the medication procurement, administration, and adherence process and guidelines. It also offers reminders of verbal education on safe handling and captures the most important information for patients to have on hand and serves as reinforcement of the information and education that was verbally provided by the medical team.

The tool was rolled out in the outpatient ambulatory care sites. Physicians and practice nurses found it easy to use, as most of the information was standardized and required them only to add the name of the medication, the dosage schedule, and the physician’s office phone number. All other information was prepopulated, including the contact information for the Smilow pharmacy.

Patient phone calls regarding the status of oral chemotherapy prescriptions were reduced, as were calls regarding clarification of administration, safe handling, and adverse events (AEs). The majority of phone calls that have been received have been related to appropriate reporting of AEs. According to the staff, patients have appreciated the take-home tool, stating that it has provided helpful written confirmation of what was discussed in the office. Physicians and staff have reported that the tool is easy to use and has been well received overall by patients.

Smilow Cancer Hospital has found that the use of a communication tool for education and information reinforcement can promote a more comprehensive understanding of a complex process and raise satisfaction among patients and the healthcare team.

Partner Perspectives

Smilow Cancer Hospital, a large academic, National Cancer Institute–designated center with 10 community locations in Connecticut, has a standardized, centralized process for oral chemotherapy prescription management to ensure safe administration to patients

Patient Communication Tool Improves Patient Satisfaction With Oral Chemotherapy Provision

Practitioners commonly treat women who have gynecologic cancer with radiation therapy to the pelvis, but it often comes at the expense of adverse events (AEs) that can disrupt sexual health.

Vaginal dryness, vaginal irritation, vaginal scar tissue, yeast infections, and infertility are some of the AEs that patients can experience, and all can affect sexual intimacy. However, these concerns are not always addressed by healthcare providers, despite the fact that patients want to talk about them.

To better understand communication and sexual dysfunction in women after radiation therapy, investigators surveyed 75 patients from the Department of Radiation Oncology at Michigan Medicine in Ann Arbor who had received a diagnosis of endometrial, cervical, uterine, vulvar, or vaginal cancer. Most of the women were white, married, heterosexual, and Christian. They were asked about their attitudes and beliefs surrounding sexual health, quality of life, and sexual function.

“The perception is that for patients [with gynecologic cancer], sexual health is not as important because they are just happy that their cancer has been dealt with,” Shruti Jolly, MD, associate professor, associate chair of community practices, and chief of brachytherapy services at Michigan Medicine, said in an interview with

®. “I think more and more [people], especially women, are focused on long-term quality of life, and sexual health is a major part of that because it affects [not only] them but also their partner. They want to have these discussions, and if the provider isn’t open, then they don’t happen.”

The investigators found that 89.8% of women experienced sexual dysfunction and 78.7% felt that sexual function was an important part of overall health.

However, the survey results showed a lack of communication between providers and patients. Of women who saw a primary care physician, 58.7% reported never or almost never being asked about their sexual health. Only 4.0% reported always or almost always being asked. Among women who saw an obstetrician-gynecologist, 22.7% said they never or almost never were asked about their sexual health and 17.3% reported being asked always or almost always.

However, 62.8% of patients felt providers should inquire about sexual health regularly. Most women surveyed did not feel embarrassed to talk about sexual health—only 12.0% reported embarrassment about provider discussions.

Women should explain to their providers that sexual health is a major concern and try to have open communication with their healthcare team, Jolly explained. “This is a very common concern,” she said. “Providers aren’t routinely educated on how to talk about these issues, and that puts more pressure on the patient to bring up these discussions.”

The investigators concluded that educating patients and providers is a necessity. “Patients need to feel empowered to push these discussions forward,” Jolly said.

Adverse Events Report

Sexual health is an important issue that nurses should discuss with their patients.

Survivors of Gynecologic Cancer Want to Discuss Sexual Issues With Providers

Contemporary nursing practice can best be characterized by 5 major themes: constant change, rapid technological advancement, evolving workforce diversity, demands for documentation, and demonstration of outcomes.

Healthcare practices related to these prominent foci have evolved and grown exponentially since the 1990s. Beginning with the advent of novel technology such as pumps, central venous access devices, and finely tuned monitors and diagnostics, the landscape of cancer care radically changed. This evolution was further affected when more advanced technology and electronic medical records entered the practice setting.

The current nursing workforce is unique. It marks the first time that 4 generations with disparate characteristics are practicing side by side. Baby boomer nurses (the oldest in the workforce, born between 1946 and 1964, with many now considering retirement) practice alongside the Gen Xers (born between 1965 and 1976), the Gen Yers (or millennials, born between 1977 and 1995, who currently make up the largest generation within the overall US workforce), and the Gen Zers (the newest of nurses, born after 1995).

 Vast and rapid social changes that occurred during each distinct generation gave each one its own defining qualities. The intergenerational reality of these groups working together poses unique relationship challenges based on expectations and values of the various cohorts within the healthcare setting.

 Differences in work ethic, engagement, and professional commitment have been documented.

Contemporary nursing continues to struggle with the integration of computerized documentation and approaches to systematically quantify outcomes of nursing practice. Many nurses consider this “extra work” and see it as labor intensive. There is much we can learn from our colleagues in other areas of healthcare who view documentation as an unequivocal necessity. Physical and speech therapists, social workers, and surgeons readily describe the positive changes based on their interventions in range of motion and mobility, diction, swallowing, coping, home reentry, and the extraction of tumors with exquisite detail. This variance in value estimation between nurses and their colleagues may be related to reimbursement.

The lack of documentation and reticence in embracing the need to quantify outcomes has significant repercussions for the nursing workforce, in areas including staffing decisions, the creation of new positions, and the allocation of monies that fund quality projects. To embrace the challenge of quantifying nurses’ work, nurses could partner with experts in their institutions, whether in the quality or finance department, to learn how to assign measurable value.

Demonstrating quality outcomes alone may not get the message about the nurses’ role as agents of change across to major stakeholders and decision makers. Rather, every project to improve patient care or enhance the delivery of nursing care must have both quality and financially measurable outcomes. In my past, I had the unique opportunity to work as a clinical nurse specialist in a setting where the hospital’s quality division assigned its staff to partner with all units. These quality specialists were nurses who knew where to find patient and financial data. They were members of all our committees, whose main goal was to assist the unit leadership in calculating the effects of nursing interventions. For example, these quality nurse experts helped the critical care team quantify the impact of a nurse-led initiative to aggressively ambulate intubated patients and reduce their length of stay. Use of this ambulation protocol resulted in over $1 million in cost savings from decreases in ventilator requirements, the need for respiratory therapy, medications, and daily intensive care unit charges. The operating room nurses lobbied their way onto a materials management committee when they identified that products were being purchased based on cost alone and not also on quality.

These nurses’ highly specialized consultation on instrument and product procurement resulted in both reduced cost and increased efficiency. Finally, over a 6-month time frame, a 30% reduction in cases of acute confusion in older patients was documented when a delirium scale was used upon admission and an early intervention protocol was implemented. This led to a decreased use of sitters and an overall reduction of charges to the unit.

Although these examples offer poignant cases demonstrating the possibilities for comprehensive outcomes documentation, a caveat is in order. Respect of the nurse’s role as a vital member of the multidisciplinary healthcare team needs some serious public relations assistance. Nursing excellence must be appreciated by those in powerful positions, and a process to facilitate this recognition needs to be established. Ask to be put on meeting agendas to share nursing initiatives. Consider which institutional leaders need to be educated about nursing work. Send them exemplars that depict successful nurse-led change initiatives and annual reports citing nursing accomplishments. These written testimonies need to be disseminated widely.

Again, there are 5 distinct contemporary expectations of nurses today. We must anticipate and embrace transition and consistently demonstrate flexibility. We must be technologically savvy and sensitive to generational diversity. Lastly, we must move beyond the perception of practice documentation and outcome measurement as extra work and embrace them as vehicles for demonstrating nursing excellence. One hundred and sixty years ago, Florence Nightingale said, “Nursing is a progressive art, such that to stand still is to go backward.”

1. Generational breakdown: info about all of the generations. The Center for Generational Kinetics website. genhq.com/faq-info-about generations. Published 2016. Accessed January 15, 2019.

2. Jobe LL. Generational differences in work ethic among three generations of registered nurses. J Nurs Admin. 2014;44(5): 303-308. doi: 10.1097/NNA.0000000000000071.

3. Shacklock K, Brunetto Y. The intention to continue nursing: work variables affecting three nurse generations in Australia. J Adv Nurs. 2012;68(1):36-46. doi: 10.1111/j.1365-2648.2011.05709.x.

4. Nightingale F. Notes on Nursing: What It Is and What It Is Not. London, United Kingdom: Harrison Bookseller to the Queen; 1859.

Nurse's Notes

Nurses must demonstrate their value in today’s challenging healthcare system.

Proving Our Worth in an Evolving Environment of Care

Debbie Cline, MSN, RN, CNL, OCN, NEA-BC - Photo by Amanda Faucett

Results from a longitudinal study on nurse turnover, funded by the Robert Wood Johnson Foundation and published in 2014, showed that approximately 17.5% of new registered nurses (RNs) leave their jobs within their first year and an estimated 33.5% leave within their first 2 years.

In 2005, about 20,000 RNs retired across the United States, and that number is expected to increase to 80,000 retirements by 2025, as baby boomer nurses reach retirement age.

 By 2026, over 3 million nursing positions in the US job market alone are expected to be open.

 Although statistics on nurse shortages specific to oncology are difficult to determine, the growing number of new cancer diagnoses (1.7 million in 2018) coupled with the estimated number of survivors by 2026 (20.3 million) signals a looming challenge for healthcare organizations in the recruitment and retention of quality oncology nurses.

Oncology Nursing News® interviewed experts from The University of Texas MD Anderson Cancer Center, University of Minnesota Health Cancer Care, and Texas Oncology to learn more about efforts under way to address the problem.

Debbie Cline, MSN, RN, CNI, OCN, NEA-BC, associate director of Nursing Workforce Planning and Development at MD Anderson Cancer Center, has spoken and written about nurse recruitment and retention for several years. Her team, which comprises 4 RNs and 2 administrative coordinators, oversees a number of recruitment and retention programs focused on various levels of need.

“The challenge of recruiting experienced oncology nurses has shifted over the years,” Cline said. “Our search efforts have expanded to include those nurses with experience in other areas, as well as new graduate nurses.”

Cline, who is an avid proponent of introducing oncology care to nursing students early on, works closely with academic partners in Houston and surrounding communities. She noted that “since 2006, we [the Nursing Workforce Planning and Development department have] purposefully increased the number of students coming through for clinicals from 100 a year to over 1400 a year.”

Cline added, “Nurses love working with students. The experience for students is amazing, and it serves as a draw to this area of nursing.”

During clinical rotations, students experience oncology nursing up close and learn valuable lessons about collaboration, communication, patient assessment, holistic care, symptom management, teamwork, ethics, care coordination, infection prevention, safety, health literacy, and much more. Students also gain awareness of the variety of opportunities available in oncology.

In addition to clinical rotations, nursing students also have access to an extern program, which is offered twice a year. This is a paid program in which 25 to 35 select students (paired with RNs) earn while they learn. The students commit to working a minimum of two 12-hour shifts a month and earn $16 per hour. Cline said the program has been a great way to find new hires, as the staff members get to know the students and evaluate whether they would be a good fit. In return, students gain a better understanding of the dynamics of oncology, the complexity of the patients, and the everyday routines of the working environment.

Elaine Stenstrup, MSN, ACNS-BC, AOCNS, BMTCN, a clinical nurse specialist for adult and pediatric oncology and bone marrow transplant at University of Minnesota Health Cancer Care, said nurses at her location also love working with students. Although the center has a low turnover rate—meaning a small discrepancy between staff who leave and new staff who join, which Stenstrup attributes to the center’s Midwest location&mdash; the institution offers several internships over a 10-week period for students who are interested in oncology or bone marrow transplant.

“The experience is rich with learning that will serve students well, regardless of where they choose to work. It’s a great experience, and many of them end up staying,” Stenstrup said. The work environment also affords nursing station technicians (nursing assistants), who are often nursing students, opportunities that are different from those in a medical/surgical unit. Many of them end up staying on once they become RNs.

“Nurse managers do a great job of talking up openings. Oncology nursing is rewarding work in many regards, but organizations need to have programs and processes in place to prevent work-related issues like burnout and compassion fatigue,” Stenstrup said.

Stenstrup also explained that exploratory days for nurses who are waiting to take their exam could be another way for the center to boost recruitment. “Spending time…on the unit and walking in the shoes of a nurse would help [students] see how well we work together,” she said. She envisions the students sitting in on change-of-shift reports the learning about a patient with a new diagnosis.

“Exposing [students] to difficult situations, then [allowing them to observe] how nurses plan to lift the patients up and get them started on the road to health, would provide them with an eye-opening experience,” Stenstrup said. “Oncology is about camaraderie, teamwork, family dynamics, and supporting patients wherever they are along their cancer journey. Exploratory days would be a great way to shine a light on the important work we do while steering potential hires to oncology nursing.”

Stenstrup said she hopes that such a program can be established at the University of Minnesota Health.

Nurse leaders play an important role in recruitment, particularly from the clinical perspective, but for talent acquisition specialists like Meggan Swierkowski, MA, of Texas Oncology, recruitment is an area they know well and do best. Swierkowski is responsible for full-cycle RN recruiting for over 170 outpatient sites throughout Texas.

“Recruitment issues seem to relate more to competition than a shortage of nurses, at least for now,” Swierkowski said.

She attributes her organization’s success with managing openings to 3 points: referrals made by employees who are happy with their work, the organizational culture, and a supportive practice environment. Although many new hires come from referrals, Swierkowski noted that because Texas Oncology provides outpatient care exclusively, the Monday-through-Friday schedules, the daytime work hours, and the lack of holiday shifts are attractive draws for many nurses. She also believes that work variety and meaningful patient—nurse relationships are another valued aspect of oncology care.

“[In] our environment, nurses really get to build that bond with their patients as they care for them from diagnosis throughout survivorship,” Swierkowski said.

Because the market is very competitive, Swierkowski added, implementing innovative strategies to attract graduate nurses has taken on more of a focus. Texas Oncology is launching 1 such strategy, a new graduate residency program for the Dallas/Fort Worth area.

“Residency programs are not new to the hospital scene, but it’s been a rare experience for us to bring on a new grad [and] get them trained and ready to work,” Swierkowski said.

Texas Oncology plans to expand the program throughout the state after the initial implementation period.

Other projects under development include a float pool of nurses trained to work throughout the facility and the addition of staff to work on an as-needed basis, both of which would allow more nurses to take time off without compromising patient care.

Oncology nursing is a labor of love. Nurses who work in oncology are indispensable to their patients, not only providing physical care and patient education but also ministering to patients’ emotional, mental, social, and spiritual needs. Without proper self-care and a work—life balance, oncology nurses may find themselves battling compassion fatigue and exhaustion, which can negatively affect them professionally and personally. Access to needed resources and support is vital to nurses’ well-being. If retention is to matter, organizations must invest in efforts that address challenges that accompany the work of oncology nursing.

Cline, Stenstrup, and Swierkowski said that for new nurses, the decision to stay with an organization often hinges more on opportunity and involvement with decision making than on pay. The new generation of nurses wants to feel valued and be recognized. Departmental and organizational leaders must take the time to find out what matters to nurses on an individual basis and encourage their involvement in committees, projects, and other initiatives to help them meet those needs.

Cline recalled being a recent graduate who had just started working in a new state and being asked to serve as quality chair. She accepted the challenge and told herself, “I can do this.” Cline suggested having regular, structured meetings with new staff and purposefully providing opportunities for them to participate, such as cochairing a committee with an experienced nurse, and coleading a quality-improvement project.

Encouraging professional development through memberships in organizations like the Oncology Nursing Society and participation in research and conferences helps keep nurses engaged and motivated. Shared governance ensures nurses are integrated into clinical decision making. Formal mentoring, clinical ladders, and leadership coaching are all strategies that practices can implement at the unit level to help nurses engage in a meaningful and practical way.

Developing relationships with staff and then maintaining those relationships, regardless of experience, are crucial steps nurse managers must take to promote retention. Cline suggested scheduling protected time for “rounding for excellence” as a way to consistently and effectively interact with staff.

Stenstrup recognized that supporting nurses is an invaluable piece of the retention puzzle, especially when it comes to self-care. One strategy she described, a Day of Remembrance, is well worth emulating. During the last 15 to 20 minutes of monthly staff meetings, photos of patients who passed away are shown on a screen and staff share memories along with what they learned from the experiences. She recounted the story of one patient who loved to dance with his wife in his room.

“There wasn’t a dry eye in the room,” Stenstrup said. It helped remind them of the depth of their patients’ lives.

In these meetings, nurses also talk about the patients who presented challenges and what was learned from them. “It’s a powerful experience,” Stenstrup said. “It also helps managers become aware of nurses or other staff members who may be having a difficult time and offer to help them work through the tough emotions experienced when a patient dies.” A social worker or a chaplain leads these remembrance sessions, and all staff are welcome to attend. Giving oncology nurse managers the opportunity to address compassion fatigue creates a more satisfying work environment for nurses and, therefore, improves retention.

Retention efforts should not be aimed solely at work-related issues, however. Practices also need to provide nurses opportunities to have fun together outside work, doing activities such as bowling and going to the beach. This helps nurses build relationships with one another and relieve some of the stress inherent in oncology nursing.

Statistics may point to an impending nursing shortage, but there are many ways that organizations can minimize the impact. Implementing creative recruitment strategies such as oncology rotations, extern programs, and nurse residencies opens the oncology nursing profession to students. Practices can also help diminish graduate nurses’ apprehensiveness and promote success by ensuring that the transition to programs is strong and supportive. In addition, taking time to build relationships with staff, giving voice to needs, and presenting opportunities for professional development and leadership all let staff know they are valued and needed. Finally, helping nurses honor their patients and recognize the powerful impact one life has on another keeps their hearts soft, their will steady, and their work meaningful.

Kovner CT, Brewer CS, Fatehi F, Jun J. What does nurse turnover rate mean and what is the rate? Policy Polit Nurs Pract. 2014;15(3-4):64-71. doi: 10.1177/1527154414547953.

Will the RN workforce weather the retirement of the baby boomers? Med Care. 2015;53(10):850-856. doi: 10.1097/MLR.0000000000000415.

Cancer statistics. National Cancer Institute website

cancer.gov/about-cancer/understanding/statistics

. Updated April 27, 2018. Accessed January 23, 2019.

Shingler-Nace A, Gonzalez J, Heuston M. Conquering compassion fatigue: lessons learned for the nurse manager. Nurs Manage. 2018;49(12):38-45. doi: 10.1097/01.NUMA.0000547836.02707.ee.

March 2019

Should Your Patient Be Driving?

Patient Communication Tool Improves Patient Satisfaction With Oral Chemotherapy Provision

Survivors of Gynecologic Cancer Want to Discuss Sexual Issues With Providers

Proving Our Worth in an Evolving Environment of Care

Recruitment and Retention Efforts Address Oncology Nursing Shortage