Wellness in Oncology Nursing Tied to Safety and Outcomes

Jennifer Bickel, MD, vice president and chief wellness officer at The University of Texas MD Anderson Cancer Center, emphasized that wellness in oncology is not about eliminating discomfort but about creating systems and environments where patients and care teams can function at their best.

She explained that wellness is often misunderstood as individual self-care, but real impact comes from system-level change. In oncology, that means ensuring clinicians are supported and able to engage meaningfully with patients and their families. When care teams are burned out or stressed, it can affect both patient experience and safety.

At MD Anderson, wellness efforts are measured through regular assessments of burnout, well-being, psychological safety and sense of belonging, all of which are tied to patient outcomes. These data are actively used by leadership to guide changes, rather than sitting unused.

Bickel emphasized that leadership plays a central role, with wellness goals tied to performance and departments supported in building healthier work environments. She also noted that removing stigma around mental health and creating targeted support, particularly for oncology nurses facing risks like compassion fatigue, are key parts of the approach.

Ultimately, she said wellness is not separate from cancer care, but essential to delivering it effectively.

In your role as chief wellness officer at the University of Texas MD Anderson Cancer Center, how do you define wellness in a way that is evidence-based and measurable within oncology care?

Bickel: I think this is incredibly important because wellness is often misunderstood. We even see cosmetic or plastic surgery described as “wellness.” But wellness, as I define it, is not the absence of discomfort or challenges. Instead, it is about creating environments, systems, and individual traits in which we can all thrive.

You describe wellness as visionary and disruptive when done right. What does that actually look like in day-to-day cancer care for patients and care teams?

I think it means recognizing that when patients and their families are in the room with doctors and nurses, that human interaction is crucial. We know that interaction is best when everyone in the room is optimized and well. We cannot expect excellent care for patients and their families when care teams are burned out, stressed, or not thinking at their best. Historically, health care has focused on advances in treatment and disease reduction, but not always on the importance of human connection. This is something that is incredibly important but often invisible. What becomes visionary and disruptive is making that invisible, important element visible.

Why has wellness historically been viewed as an individual responsibility, and how are institutions like MD Anderson shifting that mindset?

That is a great question. Wellness has often been framed as self-care: sleep, diet, exercise, mental health. But individuals can only do so much in environments that wear them down. These include environments that limit sleep, discourage open discussion of difficult experiences, or carry stigma around mental health, which can be higher in health care than in the general public. We cannot expect individuals to thrive in those settings alone.

What this looks like in practice is building systems that provide the right supports. For example, we have been recognized by Mental Health America’s Bell Seal as a platinum recipient, reflecting strong benefits, resources, and training. We are also recognized by the Lorna Breen Foundation as a Wellbeing Champion. This includes removing stigmatizing questions from credentialing, such as asking whether a clinician has sought mental health support. Historically, those questions did not protect patients but discouraged clinicians from seeking care. Removing them helps ensure patients are treated by clinicians who can access the support they need.

What kinds of data or outcomes are you evaluating to determine whether wellness initiatives are improving patient experiences or clinical outcomes?

There is extensive literature over the past decade showing that burnout is directly correlated with patient safety. We assess burnout and well-being regularly through surveys and examine their relationship with patient safety, psychological safety, and sense of belonging among staff. These factors are all connected.

Importantly, the data are used actively. Leaders review the findings together and create space to address them. The data inform initiatives rather than sitting unused. We are also building infrastructure to support local research projects so teams can develop tailored solutions. In addition, MD Anderson helped launch the ACE-QI journal, Advances in Cancer Education and Quality Improvement, which will include a focus on wellness across the workforce, survivors, patients, and caregivers.

What are some of the most promising wellness initiatives currently underway at MD Anderson, and how are they being integrated into oncology care delivery?

One of the most important elements is leadership commitment. A chief wellness officer alone is not sufficient; broad leadership support is essential. We have leadership goals tied to improving well-being and psychological safety. Departments can pursue certifications demonstrating their efforts to support team well-being, and we provide guidebooks, recommendations, and direct support.

While we offer programs and resources, leadership engagement and the environments they create are among the most powerful drivers of well-being.

What is the biggest barrier to making wellness research and programs a foundational part of cancer care systems?

One major barrier is competing priorities. In an environment focused on curing and preventing cancer, wellness can be perceived as secondary or optional. However, wellness is not separate from those goals. It is integral to achieving them.

How are you defining and advancing wellness as an evidence-based part of oncology nursing care, and what does that look like in practice?

We partner closely with leaders at the Myers Institute for Oncology Nursing. We emphasize that everyone in an organization deserves wellness, but approaches must be tailored to specific roles and risks.

In nursing, the work carries unique challenges, including compassion fatigue, rumination, and moral injury. Because of this, we must create targeted training, supportive environments, and systems that acknowledge these risks. This requires an institution-wide approach and strong collaboration to ensure nurses are supported in ways that reflect the realities of their work.

Transcript has been edited for clarity.