By all accounts, the 2020 political environment is one of the most contentious in American history. The two parties that dominate the political system, liberal and conservative, are even more entrenched in their separate ideals and doubling down during the presidential election cycle. The federal budget, immigration, and health care are the top issues discussed around the watercooler, kitchen table, and coffee shops—and of course the president’s impeachment is looming large.

Smoking cessation efforts had been gaining ground for decades. Tobacco use and smoking rates were dropping, year after year, as prevention and awareness campaigns worked to codify the dangers of tobacco. People weren’t just quitting smoking; people were avoiding the habit altogether—until the advent of vaping. Reversing a decade-long decline in smoking rates, e-cigarettes and vaping products have engendered an entirely new generation of would-be smokers to pick up the habit. Targeting underage users, the vaping industry experienced a boom. The issue grew with such ferocity that the U.S. Surgeon General declared a youth vaping epidemic in 2019.

Constitutional provisions, whose primary purposes are to create obstacles, govern the process that a bill goes through before it becomes law. The founders believed that efficiency was the hallmark of oppressive government, and they wanted to be sure that laws that actually passed all the hurdles were the well-considered result of inspection by many eyes.

Participants in ONS’s Fourth Annual Capitol Hill Days quickly saw the fruits of their efforts when two ONS priority bills were passed in the U.S. House of Representatives in October 2019. The yearly advocacy, education, and training event, held September 22–24, brought 110 ONS activists to Washington, DC, for two days of sessions, briefings, updates, and meetings. The advocates engaged in 55 hours of intensive political and policy analysis, enabling them to take the Society’s health policy priority agenda to the U.S. Congress and help transform the future of health care in the United States.

Once considered a death sentence, a cancer diagnosis was distressing and difficult on many levels. However, for the past 50 years the United States has been committed to finding treatments and cures for cancer; we have turned a corner, reversing devastating trends and changing the prognosis to one of survivorship for many.

ONS is a critical voice in the advocacy arena, helping to steward bills that are important to the future of oncology nursing practice and successful patient-centered care. On October 28, 2019, two ONS priority bills—the Palliative Care and Hospice Education and Training Act (H.R. 647) and the Title VIII Nursing Workforce Reauthorization Act of 2019 (H.R. 728)—passed the U.S. House of Representatives with unanimous bipartisan support.

As the largest ONS chapter in the United States with more than 2,000 members, the Houston ONS Chapter is primed to make an impact with the state’s lawmakers. In August 2019, chapter members did just that, combining forces with other local chapters for a pilot event featuring ONS policy education and advocacy training deep in the heart of Texas. Almost 100 ONS members participated to get support and education to speak with decision makers about the needs of the profession as well as the patients oncology nurses serve.

Vaping has become a national health issue on Capitol Hill. With more teens than ever using the devices, along with reports connecting lung injury and respiratory illness with vaping, policymakers are eager to understand the problem and act swiftly. Part of the problem includes the high levels of tetrahydrocannabinol and nicotine in vaping products. Congress is working to address the problem through several legislative bills, but few are moving as fast as the public health impact seen in news reports.

When my son was in nursery school, his teachers encouraged him to express his frustration with others by “using his words” rather than lashing out in some other nonproductive way. I was reminded of the power of words delivered by a compelling speaker when watching a video of the comedian and advocate, Jon Stewart, testifying before the U.S. House of Representatives Judiciary Committee about the needs of 9/11 first responders. His passion was evident in his voice, in his emotionally laden pauses, and in the words that he used to describe the ongoing healthcare concerns of those heroes. His strong testimony moved the committee and House to support the legislation, pass it on to the Senate, and send it to President Trump’s desk, where he signed it into law in July 2019. Stewart told a convincing story to bring others to action.

For nearly two decades, smoking rates among all ages were on the decline. Restrictions on marketing, sales, and distribution made it difficult for underage smokers to get their hands on traditional cigarettes, and adults were seeing the benefits of smoking cessation campaigns and education.

On March 26, 2019, more than 40 nurses came together at the Maryland General Assembly’s Senate President’s Conference Center for the Oncology Nurses Night in Annapolis. This was the Greater Baltimore Chapter of ONS’s (GBCONS’s) third advocacy trip to the statehouse, but it was the first statewide ONS event. All four Maryland chapters were active in planning the night, and many new advocates were inspired to speak out.

Oncology nurses advocate for their patients every day, and it’s easy to see firsthand the difference it can have in those patients’ and families’ lives. But there’s a way to make an even larger impact by using those same advocacy skills at the local, state, or even national level—potentially changing thousands or even millions of lives of patients, survivors, and families across the United States.

Washington is the first state in the country to offer a public insurance option to its residents after Governor Jay Inslee signed the bill into law on May 13, 2019. Is it any coincidence that Inslee is also running for president? Coming from a traditionally “blue” state with a strong progressive legislature allowed this Democratic candidate to deliver on a particularly interesting policy.

After recent a best-selling book-turned-movie detailed her story, Henrietta Lacks’ extraordinary impact on cancer research continues to become common knowledge to more people. However, many more are still unaware of how her story, struggle with cancer, and tumor cells changed the face of cancer care. For that reason, Representative Elijah Cummings (D-MD), along with a congressional delegation from both chambers, introduced legislation to both honor her role in history and improve access to medical research to traditionally underrepresented groups.

Advocacy is a pillar for both ONS and me, personally. As a professor, organizer, chapter leader, and now ONS president, engagement in oncology nursing issues is an essential part of what I do and who I am. In March 2019, I accompanied ONS staff along with my ONS Pittsburgh Chapter colleague, Grace Campbell, PhD, MSW, RN, CRRN, assistant professor at the University of Pittsburgh, to meet with Congressional Representative Connor Lamb’s (D-PA) district office director.

In a bold move, Senate Majority Leader Mitch McConnell (R-KY) announced on Thursday that he would put forward a bill to raise the national age for tobacco product purchases to age 21. It’s a remarkable move on many levels, not the least of which is that McConnell is from Kentucky—a region of the country that produces tobacco products. More importantly though, McConnell made a public statement about the rise in youth consumption through vaping.

For more than five years, the cancer advocacy community—along with the larger healthcare environment—has presented and promoted a comprehensive piece of legislation focusing on patient-centered care, palliative care training, and hospice education. Advocates are familiar with the Palliative Care and Hospice Education and Training Act (PCHETA)—an initiative that contains many of ONS’s policy priorities and one that ONS members have lobbied for on Capitol Hill.

Each spring marks a new budget season in Washington, DC. It’s a time of year that provides a glimpse into policy priorities for the fiscal year. In March 2019, the Office of Management and Budget released its 2020 funding allocations for the entire federal government. The budget was comprised after each federal department spent the preceding months looking at their previous year’s budget and outlined programmatic priorities that align with the president’s agenda.

As an oncology advanced practice nurse and administrator for cancer services, every day I care for patients and caregivers coping with cancer. I mentor nursing staff in best practices to deliver care, and I create a work environment conducive to advancing quality cancer care. However, my commitment to supporting people with cancer does not end at the walls of my workplace.  Oncology nurses are called to be a visible change agent in our communities—and beyond—to continue the worthy work of championing quality care for people diagnosed with cancer, along with spreading prevention and early detection information.

In early January 2019, I had the opportunity to represent ONS before the Virginia State Senate Finance Committee on the growing epidemic of electronic cigarettes and vaping device use among youth. In Richmond, VA, I delivered testimony about the dangerous health ramifications of this newer trend of tobacco use.

When heads of federal regulatory agencies are health and medical professionals with years of research experience, their background helps guide the mission and vision of the department along with the direction of thousands of staff and employees engaged in implementing health policy. U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, MD, is a clinician and activist, and he acts as a staunch advocate for public health issues—namely the dangers of tobacco use, especially among young Americans.

How often have you gone to the mailbox, pulled out your latest issue of the Oncology Nursing Forum or Clinical Journal of Oncology Nursing, and excitedly read about some innovative study with game-changing outcomes that’ll revolutionize the delivery of health care—only to find that it never moves off the pages of the journal? What does it take to move research from the proverbial bench to the community? That was the focus of the Fourth Annual Meeting of the Patient Centered Outcomes Research Institute (PCORI), “From Evidence to Impact: Putting What Works into Action,” held from October 31–November 2, 2018, in Washington DC. 

On the heels of celebrating our nation’s servicemembers on Veterans Day, the U.S. Department of Veterans Affairs (VA) issued a report that indicated it was struggling to treat veterans with cancer because of a lack of healthcare specialists. For years, the VA has faced challenges with filling hospital job openings in all positions. The resulting administrative and oversight issues are only hurting those most in need of its services. To find out that cancer incidence rates are higher in those who’ve been a part of active war zones—and that the agency is unable to meet their needs—is a sad state for our nation’s vets.

On January 3, 2019, the newly elected, Democrat-controlled House of Representatives introduced legislation to reopen the federal government and end the current shutdown. It’s not about the money, which is usually the case; it’s about the blame. The border wall funding—in whatever capacity—is politically driving the shutdown. But Senator Mitch McConnell (R-KY) doesn’t want to take up a Democrat-sponsored bill that he knows the president will veto. Democrats want that to happen to force the president to either accept the blame for the shutdown or to cave without funding for the wall and reopen the government.

Election results may appear to be seismic shifts, jarring the foundations of the American political system to its core as voters stare in disbelief, attempting to translate the meaning of the public’s intent. But is that really the case?

Before the hustle and bustle of the holiday season, I wanted to thank you, our ONS members, for advancing the voice and contributions of oncology nurses to critical issues in cancer care.

Nurses should initiate financial conversations with patients early and offer resources to improve access to cancer care, speakers at the ONS Center for Advocacy and Health Policy’s third annual policy summit on November 13, 2018, concluded. The event, held at the Hyatt Regency Hotel on Capitol Hill in Washington, DC, brought together nurses and industry and government experts to address the issue of financial toxicity in today’s cancer care.

As a staunch advocate for the advancement of cancer treatments, research, and patient care, President George H.W. Bush left an enduring legacy through contributions to the field of oncology and health care in the wake of his death on November 30, 2018. His continued support of healthcare professionals—including oncology nurses—spoke to his administration’s focus before, during, and after his tenure in Washington, DC.

Washington insiders weren’t surprised by the election’s outcome, and the next session of Congress will be something to watch in 2019. However, the current work of politics in a lame duck session can be interesting at best and potentially dangerous at worst. Members of Congress who lost their seats are now under no obligation to their districts, leadership, or party and often vote their conscience on late-session bills.

After an arduous campaign season, the midterm election results are mostly as anticipated. The Democrats gained seats in the House of Representatives, giving the party the majority in the lower chamber starting in January 2019. The Dems say their focus for the next congressional session will focus on health policy and high drug prices. Although the jury is still out over what the midterm elections meant, most experts agree that health care was the driving political issue for voters, regardless of party.

On September 12, 2018, I had the honor of attending the Nursing Community Coalition’s (NCC’s) 10th Anniversary Celebration as an ONS representative, joining members of ONS’s health policy staff. NCC is a 61-member coalition, working to further nursing education, training, and support through united advocacy efforts.

ONS, like so many membership organizations with dedicated healthcare interests, oils the gears that move the public policy machine forward. Each shift represents another opportunity for success. One such tactic is working in coalitions, and ONS is a vital member of health advocacy groups in Washington, DC, usually as the only nursing society at the table.

As the U.S. government’s arm of patient-centered research, the Patient-Centered Outcomes Research institute (PCORI) is driving new initiatives and opportunities focused on unlocking novel treatment methods and cutting-edge interventions to better care for patients. On September 24, 2018, PCORI announced its new Board of Governors, naming ONS member Christopher Friese, PhD, RN, AOCN®, FAAN, as the agency’s first nursing research representative to hold a seat on the board.

As an oncology nurse, I’m grateful to work alongside so many colleagues who bring dedication, grace, and skill to their work. No other industry in the world shares the same frustrations or emotional tolls as nursing, but we continue to bring enthusiasm, optimism, and devotion to our daily work. Nurses strive to ensure the best for their patients. It’s the call to patient advocacy that is at nursing’s core.

In May 2018, I participated in the American Cancer Society’s (ACS’s) Cancer Action Week in my role as a legislative volunteer for ACS’s Cancer Action Network (CAN). In this role, I advocate on the state level for various key legislative efforts for people with cancer in New Jersey.

’Tis the season. Well, at least in DC, it’s an exciting time. A political year. A long summer recess. A host of bills that are on the verge of passing. We are all aflutter with anticipation of the possibilities. But legislators need to remember who sent them to Washington and for what reason. Advocacy begins at home, and elected officials are heartened by what their constituents request, especially when that legislation is bipartisan and emotional and can affect people’s lives.

On June 27, the House Energy and Commerce Subcommittee on Health passed by voice vote two health bills that have been among ONS’s top legislative priorities: the Palliative Care and Hospice Education and Training Act ([PCHETA], H.R. 1676) and the Title VIII Nursing Workforce Reauthorization Act (H.R. 959). The bills are now poised for consideration by the full House Energy and Commerce Committee.

Recently, immigration policies have come front and center in the news. The issue of separating children from their parents at the border was elevated to a public health issue, as the American Academy of Pediatrics—among other healthcare organizations—decried the Trump administration’s policies, noting the potential for irreparable harm to children. ONS was one of the many provider groups that sent formal letters to the Department of Homeland Security, encouraging change to immigration policies that separate children from their parents.

In our nation’s capital, healthcare policy meetings occur weekly for various government and private organizations whose aim is to improve care and conditions for patients with cancer. The ONS National Capital Chapter members are involved in lobbying on the Hill and attending meetings about improving cancer care through the ONS Capitol Hill Gang.

In today’s increasingly fractured political environment, with heightened partisanship, Washington, DC, has become toxic. New ideas and common-sense solutions are rare and promoting issues without politicization is literally a full-time job. Interest groups are now finding policy opportunities for success in the state capitals. Some advocacy initiatives have found easier, and faster, wins for their organizational efforts at the state legislature level.

ONS President Susan Schneider, PhD, RN, AOCN^®, FAAN, was appointed to the Biden Cancer Initiative board of directors, among other experts in health care, business, finance, and technology. The Cancer Initiative also named ONS Chief Executive Officer Brenda Nevidjon MSN, RN, FAAN, to its advisory committee, comprised of 25 other experts aiming to transform the way cancer is detected, diagnosed, and treated by implementing new solutions to complex healthcare problems.  

The U.S. Congress continued its budget pattern in February, enacting another extension of the 2017 budget agreement into law on February 8, 2018. The current iteration of the budget law will raise caps on defense and non-defense spending over two years and keep the federal government running through March 23, but more importantly, it includes the following provisions of special interest to ONS.

Each day, more than 175 Americans die from an opioid-related overdose. Misuse of, addiction to, and overdose from opioids cost the United States $78.5 billion a year, “including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”. Other alarming numbers abound: 21%–29% of patients who are prescribed opioids misuse them, 4%–6% of those transition to heroin, and 80% of people who use heroin first misused prescription opioids.

Thousands of pieces of legislation are introduced in each Congress, but only a small percentage make it through the entire process, especially in that first year. Bills that are not voted into law and signed by the president during that two-year period “die” when the second session is completed and Congress adjourns. According to congressional rules, “A bill may be introduced at any point during a two-year Congress. It will remain eligible for consideration throughout the duration of that Congress until the Congress ends or adjourns sine die.”

Breakthroughs and advancements in research and management have significantly changed the ways we understand how cancer works and how best to treat it. Recently, the Centers for Disease Control and Prevention (CDC) released its Annual Report to the Nation on the State of Cancer.

On November 3, 2017, the House of Representatives passed HR 3922, the Championing Healthy Kids Act, which reauthorizes the Children’s Health Insurance Program (CHIP) program for an additional five years. The act also reauthorizes public health programs. Previous funding for the CHIP program had expired September 30, 2017.

The Centers for Medicare and Medicaid Services (CMS) finalized a rule on November 1, 2017 that would reduce the current Medicare Part B drug payment to 340B hospitals from average sales price (ASP) plus 6% to ASP minus 22.5%.  However, rural sole community hospitals (SCHs), children’s hospitals, and PPS-exempt cancer hospitals are excluded from this payment adjustment in 2018.

In May 2017, Scott Gottlieb, MD, was named as the newest U.S. Food and Drug Administration (FDA) commissioner. He’s since shown a commitment to regulating tobacco and nicotine delivery systems—such as e-cigarettes—especially when it comes to children. In one of his public forums, Gottlieb spoke about the FDA’s commitment to continued oversight and regulation of these products and their distribution, a stance that’s drawn support from the medical community.

As part of its mission, ONS honors and maintains nursing’s historical and essential commitment to advocacy for the public good. Working collaboratively with policymakers, cancer and nursing community advocates, and other stakeholders at the local, state, federal, and international levels, ONS seeks to integrate the nursing perspective throughout the policymaking process and urges that oncology nurses be appointed to all relevant federal panels, committees, commissions, and boards. During its September conference call, the ONS Board of Directors focused on two key areas of ONS advocacy.