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.

Palliative care is a necessary inclusion in the care of all people with a serious illness, no matter the diagnosis or setting, and it’s the responsibility all healthcare providers, including specialty providers in oncology. The National Consensus Project (NCP) expanded on these two key tenets in its new release of the fourth edition of the Clinical Practice Guidelines for Quality Palliative Care. ONS is one of 80 organizations endorsing the new guidelines.

When Senator John McCain (R-AZ) passed away in August 2018 from aggressive glioblastoma just one day after his family announced he stopped treatment, it put a poignant highlight in Washington on a need of which oncology nurses are far too aware: palliative care and hospice. Ideally, palliative care begins at the time of a cancer diagnosis and is aimed at managing symptoms throughout the cancer journey. Hospice begins when a patient’s prognosis is six months or less, yet in most cases, as McCain’s illustrates, patients begin hospice far too close to death. Many point to a lack of awareness and education—for patients and the public as well as oncology nurses and other palliative care providers.

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 this important midterm election approaches, my hope is that all ONS members recognize the importance of raising our collective voices as we elect our next leaders at the local, state, and federal level on November 6. In the words of former First Lady Michelle Obama, “It is more important than ever that we show up to vote, not just this year, but every year and in every election. Every voice must be heard, and every vote must be counted.”

Advance care planning (ACP) is a process for patients and their families to discuss their wishes and goals of care for treatment and end-of-life care, clarify related values and goals, and state preferences through written documents and medical orders. In situations where a patient’s decision-making capacity is limited, healthcare providers turn to family members to make decisions. When no ACP conversations have occurred between patients and their families, family members are left to make decisions regarding life-sustaining treatment without input from the patient or with little knowledge of the patient’s wishes.

The breadth of understanding that can come from a face-to-face conversation is hard to underestimate. More than 100 oncology nurses discovered the power of advocacy, education, and one-on-one conversations during ONS’s 2018 Capitol Hill Days in Washington, DC.

Addressing the high cost of prescription medications has been an ongoing focus for the Trump administration. Its latest move, requiring drug companies to list their product’s market price on consumer ads, is an added level of transparency that didn’t exist before. Whether the decree will have an impact remains to be seen, but it may add some trust to the process.

When Senator John McCain (R-AZ) passed away in August 2018 from aggressive glioblastoma just one day after his family announced he stopped treatment, it put a poignant highlight in Washington on a need of which oncology nurses are far too aware: palliative care and hospice. Ideally, palliative care begins at the time of a cancer diagnosis and is aimed at managing symptoms throughout the cancer journey. Hospice begins when a patient’s prognosis is six months or less, yet in most cases, as McCain’s illustrates, patients begin hospice far too close to death. Many point to a lack of awareness and education—for patients and the public as well as oncology nurses and other palliative care providers.

To meet or maintain Magnet designation, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program expects organizations to incorporate specialty standards and guidelines into the care delivery system. 

What comes to mind when someone mentions Brazil? Do you think soccer? The 2016 Rio Olympics? Carnival? The Amazon rainforest? Although all of those are true, even more impressive is what’s happening in oncology nursing throughout Brazil. In August 2018, a small group of dedicated Brazilian oncology nurses—many of whom are ONS members—hosted the Inaugural Oncology Nursing Brazil 2018 conference in Sao Paulo.

As a continuation of the National Cancer Moonshot legacy, the Biden Cancer Initiative (BCI) announced its inaugural roster of FIERCE Award recipients, naming 10 transformative healthcare professionals and institutions who have driven change and positively impacted the lives of their patients with cancer. For her work as an oncology nurse navigator and her accomplishments in patient navigation, ONS member Cynthia Cantril, RN, OCN^®, CBCN^®, MPH, was named one of the BCI’s FIERCE Award recipients at the Biden Cancer Summit Welcome Reception in Washington, DC, on September 20, 2018.

Most emergencies can manifest in the blink of an eye. Whether it’s a medical emergency, a car accident, an act of nature, or something else, emergencies are sudden crises that require swift, immediate action. For many patients with cancer, among the most distressing challenges along the treatment journey is the possibility of experiencing an oncologic emergency.

While awaiting the arrival of Hurricane Florence last month, I took the opportunity to purge the proverbial closets. One contained dozens of VHS tapes. I had no need to keep most of them, but one caught my attention. “Focus: Specialty Nursing” was produced by the National Nursing Network. The video referenced how changes in the healthcare system were resulting in increased nursing specialization and a growing number of specialty nursing organizations. Leaders of specialty nursing organizations who were attending the National Federation of Specialty Nursing Organizations (NFSNO) annual meeting were interviewed. The tape is not dated, but I am guessing it was produced in the late 1980s because Deborah Mayer, PhD, RN, AOCN^®, FAAN, ONS president from 1987–1989, discussed oncology nursing.

Building on a long career as a pioneer in oncology nursing research and cancer clinical trials, ONS member Deborah Watkins Bruner, RN, PhD, FAAN, has been named the senior vice president of research at Emory University in Atlanta, GA, a newly created position that serves on the Emory president’s leadership team. Effective October 1, 2018, Bruner’s leadership, expertise, and research experience will guide Emory’s interprofessional research efforts and promote education and training for future researchers, including nurse scientists.

Like all great adventures, it began as an idea. What if the United States could make huge advancements in the fight against cancer in a short amount of time? How could that be accomplished? What are the metrics? How much would it cost? Who could direct such an effort? 

As a hematology and oncology nurse, I’ve seen countless patients in treatment and recovery, and I’ve seen some lose their fight against cancer. In June 2018, I had the privilege to represent ONS as the sole nurse selected to advocate for palliative care with one of ONS’s coalition partners, the Patient Quality of Life Coalition (PQLC), where I was able to share my perspective and the many aspects of my role as a nurse with congressional staff. As the sole practitioner in the five congressional meetings, I provided insight about how nurses interact with patients, particularly during cancer treatment.

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.

Senator John McCain’s (R-AZ) family announced on August 24, 2018, that McCain has elected to stop treatment for his glioblastoma, a rare and aggressive form of brain cancer. Although his health had surpassed his original prognosis for many months, “the progress of disease and the inexorable advance of age render their verdict. With his usual strength of will, he has now chosen to discontinue medical treatment,” his family explained.

Cancer doesn’t discriminate. It can strike anyone at any time. Being told that you have cancer can be a frightening experience, and feelings of loneliness and isolation are not uncommon, especially for young adults with cancer.

Each spring brings a flurry of annual meetings held by oncology organizations: Association of Community Cancer Centers (ACCC), American Association for Cancer Research (AACR), American Society of Clinical Oncology (ASCO), and ONS’s. This year I attended all and was part of panel presentations at ACCC and AACR to bring the nursing perspective to the topics. 

For many patients with cancer, surgery is an integral part of the treatment regimen and offers a chance for a cure. This is especially true for patients with pancreatic cancer, where surgery is currently the only potential cure for the disease and a predictor of long-term survival. 

I have learned a good deal about leadership through networking and leadership opportunities with my local ONS chapter, project teams and task forces, and serving as a board member.

When physician-assisted death mandates were passed in states like Oregon, Washington, and California, guidelines were established for practitioners as part of election mandates. However, in states like Montana and Vermont, the legalization of assisted death went through the legislature without process and practice guidelines. Therefore, practitioners have little or no framework to implement the process of medical aid in dying.

Imagine being in a hospital, unable to verbally communicate and having to find a way to get across your basic human needs. As oncology nurses, we take care of a variety of different patients: some able to make their needs known and some who unfortunately cannot.

It’s a rote but important phrase: Necessity is the mother of invention. When a need presents itself, developing novel, inventive solutions can lead to important change. But inventive change doesn’t have to come on a massive scale: small inventions can still have a big impact.

It’s the season for graduations. My husband and I recently celebrated our youngest daughter’s graduation from Saint Louis University School of Nursing—just as we did for our two older daughters. As I reflected on this time of celebration, I was reminded of when I was asked to write for Continuing the Legacy: More Voices of Oncology Nurses, an ONS book that shares the narrative history of oncology nursing through individual nurse stories. I wrote about a patient who taught me a lot during our time together. At the end of each story, the authors were asked to reflect on their contributions and their experiences. With all of the celebrations lately, I had to look back on what I wrote.

Misconceptions about radiation treatments, associated side effects, and impact on patient care still permeate medical oncology for patients and providers alike. As educators, patient advocates, and caregivers, radiation oncology nurses play a critical role in the successful treatment and support of patients with cancer.

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.

Financial toxicity in cancer care is an increasingly recognized burden for many patients. Driven by many factors, financial toxicity is often a combination of a patient’s individual characteristics, the costs associated with care, and the overall impact of the illness on a patient’s ability to work throughout the cancer journey. Financial toxicity negatively impacts patient outcomes, and many patients struggle with costs regardless of whether they’re covered by health insurance—this includes undocumented immigrants. Currently, more than 11.1 million undocumented immigrants live in the United States, and they aren’t immune to cancer diagnoses.

Having an outlet to consider, discuss, and reflect on oncology ethical issues that affect our daily practice is important in caring for each other in our profession. On our solid tumor oncology unit, monthly nursing ethics lunch and learns allow our nurses the opportunity to identify and discuss their concerns with recent patient cases involving ethical issues. Our hospital’s ethics committee chair facilitates the hour-long discussions held on the unit, along with a senior oncology nurse with significant training and background in clinical ethics.

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.

As a student graduating from a traditional four-year bachelor of science in nursing program, career opportunities in nursing are seemingly endless. It’s exciting to enter a field that involves helping and caring for people and provides an opportunity to work with patients of all different cultures, ethnicities, ages, and personalities. I initially chose a nursing career because I’ve always been interested in the science of the body. I love making connections and communicating with people, and I have a passion for helping people get through their worst times. As a student, the only goal I had as an aspiring nurse was to work in pediatrics.

Writing and publishing for the first time can be a daunting experience, but the Clinical Journal of Oncology Nursing (CJON) Writing Mentorship Program is a great opportunity for oncology nurses looking to publish their own work. The program pairs published nurses who share their experiences and expertise with ONS members who are new to the publishing process.

In coffee shops around the country, between clicking cups and grinding coffee beans, former second lady of the United States, Jill Biden, EdD, is quietly gathering small groups of oncology nurses, care coordinators, social workers, and family members who support patients with cancer to discuss the obstacles facing caregivers throughout the cancer journey. As part of the Biden Cancer Initiative’s (BCI’s) continued work to improve oncology care, this coterie of caregivers is heralding the trials and triumphs that come with addressing the physical, social, emotional, and spiritual needs of patients with cancer.

April is designated as National Cancer Control Month in the United States. It’s a federally endorsed observation, annually encouraged by a proclamation from the president. April is dedicated to raising awareness for cancer prevention and treatment throughout the country. Approved through a joint resolution by Congress in 1938, the yearly presidential announcement serves as a reminder to all Americans that awareness of the factors that cause or prevent cancer are crucial to the public health.  

As I reflect on my time as ONS president, I realize that I am concluding my term as I began: grateful for the oncology nurses who have inspired and supported me. We are all guided by the common goal to provide the best possible care to individuals with cancer. 

Focusing on a patient’s quality of life is often a key component to their successful cancer journey. Treating their disease is crucial, but patients have to be recognized as individuals with unique and varying needs. Addressing their emotional, physical, spiritual, and psychosocial stressors can help provide holistic treatment that’s at the heart of successful oncology care.

On February 14, 2018, Valentine’s Day, I had the honor of representing the ONS at the Congressional Families Caucus with Alec Stone, ONS director for public affairs, who made the connection between Congressional Families and ONS. The Congressional Families Caucus is made up of spouses of congressional members serving in the House of Representatives and Senate.

The old saying, “it takes a village,” comes to mind. Many team members are needed to help a patient through one of the most critical times of their lives. Blood and marrow transplant (BMT) nurses play a large role, along with BMT physicians. However, we also depend on our BMT pharmacist, BMT dietician, and BMT social worker as part of the interprofessional team. Our patients not only need excellent nursing and medical care, but they also need care from members of the team to support them physically, psychologically, and nutritionally from transplant prep through the transplant itself and into the recovery phase.

When faced with a difficult problem, it’s human nature to seek different perspectives, to work together with others facing similar issues to accomplish a common goal. Compromise, collaboration, and communication are essential to successful teams—whether it’s your daughter’s basketball team, the U.S. government, or any group in between. In oncology, teamwork is no different. Bringing together professionals from different disciplines can yield tremendous results for patients with cancer.

The white dress, emblazoned with a red medical cross, might be one of the most well-known fiction tropes about nursing, but it isn’t the only one—not by a longshot. In TV shows, movies, books, and more, nurses are often depicted in stereotypically inaccurate ways. Those misrepresentations paint a wildly incomplete picture of nursing’s role in patient care, often leading to real patients who misunderstand the crucial role nurses play in their care.

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.  

ONS member and oncology nurse, Kevin Sowers, MSN, RN, FAAN, former president of Duke University Hospital in Chapel Hill, NC, was appointed president of the John Hopkins Health System and executive vice president of Johns Hopkins Medicine, both in Baltimore, MD, on December 8, 2017, and begins his tenure on February 1, 2018. He is only the second person in Johns Hopkins history to hold these dual roles.

Young authors have so much to share, and they shouldn’t think that what they have to say isn’t worthy of publication just because they’re young. I’ve had the privilege of mentoring young authors on many occasions. Recently, I had the joy of watching a novice author actually open a journal and see her article in print. It was made even more special because it was my daughter, Elaine, who is a senior nursing student at Saint Louis University School of Nursing. She shared her personal story about her decision to become a nurse in the Clinical Moment feature in the Clinical Journal of Oncology Nursing’s (CJON’s) October 2017 issue.

Building relationships with patients is just one of the many roles of oncology nurses. However, it’s generally not possible to see your patients every day. This isn’t uncommon, but it can pose problems to oncology professionals treating patients with head and neck cancers.