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.1
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.2
By 2026, over 3 million nursing positions in the US job market alone are expected to be open.3
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.4
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— 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.5
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.
- Auerback D, Beurhaus P, Staiger D. 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.