At first this seems like a bold statement, but think about it for a moment. What do we know about Florence Nightingale? She is credited as the founder of modern nursing and embodied nursing leadership and advocacy. She improved hygiene practices in hospitals, resulting in fewer infections and deaths. She pioneered statistical analysis on the conditions surrounding the provision of medical care, especially during the Crimean War, and used visual presentations (or early infographics). She created patient services, such as a kitchen that prepared special dietary meals for patients, a laundry to provide clean linens, and a library for patients’ intellectual stimulation.

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.

Tobacco, obesity, alcohol, diet, and physical activity are major risk factors for cancer, yet all are modifiable, according to findings released in a new report from the American Cancer Society. Reducing tobacco use is the highest priority, but interventions for all five risk factors are essential for a comprehensive U.S. cancer control plan.

As the number of cancer survivors continues to increase, more oncology-trained nurses are needed to care for this population. Unfortunately, not all schools of nursing have clinical experiences in the oncology setting. However, the University of North Carolina leadership is committed to increasing the pipeline of students interested in caring for patients with cancer and their families through an innovative summer fellowship program.

The new 116th Congress has settled in, and a clearer picture of the diverse freshman class has come to light. In this case, nursing is present and accounted for among incoming congressional representatives. Lauren Underwood (D-IL) is an RN who ran on her support for health care, specifically to protect those with pre-existing conditions. She’s already a co-chair of the Congressional Nursing Caucus and has signed on to Title VIII nursing reauthorization legislation—something ONS has continually championed. Representative Eddie Bernice Johnson (D-TX)—the first nurse ever elected to Congress—is entering her 13th term in the chamber and continues to offer a veteran nursing presence on the hill.

Nearly 20% of Americans experience mental illness in a given year, according to the National Alliance on Mental Illness. With diagnoses such as schizophrenia, bipolar disorder, or major depression, about one in every 25 Americans suffers from a serious mental illness that directly affects major life activities. The prevalence of mental illness in the United States can have a downstream effect on cancer care and patient outcomes, and with these statistics, oncology nurses may encounter patients with cancer who have pre-existing psychiatric disorders. Healthcare providers in fields outside of psychology need to be prepared to address the unique needs and individualized care required to support this patient population during and beyond cancer treatment. 

Public opinion surveys from respected groups such as Gallup serve as a barometer on certain topics and issues. In Gallup’s 2019 poll assessing ethics and honesty, nurses were again ranked the most-trusted profession in the United States for the 20th year. In 2019, 84% of respondents said they rated nurses “very high” for honesty and ethical standards, leading the pack by a wide margin. Patients, families, and caregivers know firsthand that nurses are driving patient-centered care. For that very reason, they rank nurses higher than physicians, clergy, police officers, and educators. It’s a position that commands respect.

Nestled between Tanzania and Mozambique in eastern Africa, Malawi is a country of more than 18 million citizens. It faces a unique cancer burden that’s proven challenging for practitioners and patients alike. With a high prevalence of HIV-infected individuals, Malawi sees a proportionate rate of AIDS-related cancers, including Kaposi sarcoma, cervical cancer, and non-Hodgkin lymphoma. Currently, healthcare professionals in the country face a lack of standardized oncology education and resources. Roughly 84% of the country’s citizens live in rural areas with limited access to healthcare institutions.

Despite flashy television campaigns, countless pamphlets and brochures, and seemingly constant reminders, people are still unaware of important cancer prevention information. The World Health Organization estimated that 30%–50% of all cancer cases are preventable. But between modifiable behaviors, hereditary and genetic risks, infectious agents, and more, the general public finds itself mostly unprepared to tackle the cancer prevention conversation.

Since 2016, ONS has gathered hundreds of nurse advocates in the nation’s capital to speak truth to power during its annual Hill Days conference. This two-day meeting brings more than 100 oncology nurses to Washington, DC, to learn about the Society’s health policy legislative agenda and to be trained in how to educate elected officials on the priority issues most important to ONS members.

From her patients to her colleagues to the entire cancer care community, ONS Past President Sandra Lee Schafer, RN, MN, AOCN^®, made everyone she touched feel special, inspiring and motivating a generation of oncology nurses in advancing care for patients with cancer. Schafer passed away on December 7, 2018, but her legacy of compassion and care lives on.

People often use idioms—such as “going under the knife” as a euphemism for surgery—to avoid confronting distressing situations, which is even more pronounced when it comes to life events as serious as cancer. But for many patients with cancer, undergoing a surgical procedure is key to positive outcomes, and they count on the expert clinical care and support of their surgical oncology nurses to see them through it.

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.