Cancer care is always changing, new science is constantly developing, and oncology nurses must work to keep up. ONS’s philosophy is that every nurse has room to develop knowledge, practice, and research. As an organization, we embody a commitment to lifelong learning and professional development because we understand that both are crucial to oncology nursing and patient outcomes.

When I sat for the very first Certified Pediatric Oncology Nurse (CPON^®) examination through the Oncology Nursing Certification Corporation in 1993, I had no idea how obtaining my certification would positively affect my career. I was one of four nurses from the University of North Carolina Hospitals who felt strongly as a group that we could and should pursue our CPON^® certification, and we all passed the exam together.

Up to $85.3 million of the U.S. Department of Health and Human Services’ (HHS’s) $107.2 million in funding awards is earmarked for nurses. The agency bestowed the awards in June 2020 to 310 recipients across 45 states and U.S. territories to increase the healthcare workforce in rural and underserved communities.

Today’s new normal has changed everything at home, from what we wear to how we teach our children—and in the oncology nursing workplace, from new precautions to the rise of telehealth. It’s also affected nurse residency programs, but one institution has thrived as it adjusted.

New nurses are a lot like new drivers: they know just enough to pass the test but lack the experience to influence critical decisions. Those who understand the importance of continuing education in various formats have an advantage in today’s competitive job market.

In nursing school I was always taught to maintain professional boundaries with patients, including never sharing any personal information like my address or contact information. No matter how many times faculty members said it, we never role played scenarios with that situation. I was unprepared for the moment, six months into my nursing career, when a kind, gentle, nonthreatening woman asked me for my address so she could send me a Christmas card.

When oncology nurses speak, people listen. An op-ed column published February 24, 2020, written by ONS member Janice Phillips, PhD, RN, FAAN, outlined the potential harm to the future of health care and the nursing profession if the Trump administration’s budget cuts are approved. As an oncology nurse, Phillips’ insights have made a difference in Washington before, and she explained that the budget cuts could target key funding for items like nursing development and workforce programs.

Cancer occurs from mutations, or harmful changes from an alteration in a gene’s DNA sequence. Most mutations involve changes in the order of the base pairs, including substitutions, deletions, additions, or shifts. Mutations can be divided into broad categories based on the tissue where they occur.

U.S. and European oncology nurses might feel out of their element in a Russian model of nursing practice, which is considerably different than what they’re used to in their own countries. For example, Russian nurses mix all chemotherapy infusions for patients and have no access to pharmacists. Russian blood and marrow transplant (BMT) units have a much higher ratio of physicians to nurses than what’s traditionally seen in other parts of the west. But, like nurses around the world, Russian nursing professionals are keenly interested in improving their oncology practice—although they typically receive education in an academic rather than technical setting.   

Genetics versus genomics: Is there a difference? Does it even matter? There is, and it does. In our era of precision medicine, also referred to as individualized or genomic medicine, being able to differentiate the terms is a first step in establishing a foundational understanding of what they mean for cancer care from prevention to treatment.

By bringing together gero-oncology experts from the ONS membership, staff, and leadership, the ONS geriatric oncology group is identifying gaps in geriatric oncology nursing research and care and connecting ONS members with available resources targeting this vulnerable population. Adult patients with cancer—aged 65 and older—already make up a majority of patients that oncology nurses see. Despite the population’s prevalence throughout cancer institutions and clinics, many nurses are not acutely familiar with the specialized care required to successfully help them navigate their treatment.  
 

The Palliative Care and Hospice Education Training Act (PCHETA) is a key ONS policy priority. After unsuccessfully navigating both chambers of the 115th Congress prior to the 2018 midterm elections, the bill had to begin its legislative journey once again in the new 116th congressional session.

The Fitzpatrick Classification System Determines How Much UV Protection Is Needed to Prevent Sun Exposure

True or False?

Leadership, integrity, inclusion, and diversity were common threads in several discussions during the ONS Board of Directors’ conference call on May 21, 2019. In addition to finalizing plans for their participation in the Leadership Think Tank, which will be held on July 22–23, 2019, the Board made the following decisions and approvals. 

During the  44th Annual ONS Congress in April 2019, some sessions featured a Continuing the Conversation event following the main session. As a speaker, this might have been the best part for me. It was filled with unexpected, wonderful surprises and great conversations with oncology nursing colleagues.

Which tumor marker can be used to assess stage, prognosis, response to treatment in germ cell tumors, lymphoma, melanoma, acute leukemia, and neuroblastoma?

A. Programmed death ligand 1 (PD-L1)

B. HE4

C. Cytokeratin fragment 21-1

D. Lactate dehydrogenase

Depression, anxiety, post-traumatic stress, and cognitive difficulties are just some mental health concerns that can affect cancer survivors: those living with, through, and beyond a cancer diagnosis. As many as three out of every four cancer survivors can experience acute or chronic symptoms of psychological distress, which can negatively affect quality of life, engagement in follow-up care, and health outcomes.

Professional development needs of oncology nurse navigators (ONNs) have not been clearly identified, both for novice and more experienced navigators. Although some work has begun to define training for novice ONNs, most information about education for experienced ONNs comes from evaluation data and anecdotal reports.    

In an increasingly rare show of bipartisan common ground, U.S. Senators Todd Young (R-IN) and Doug Jones (D-AL) introduced the Nursing Where It’s Needed (Nursing WIN) Act in April 2019. The bill would assist nurses in underserved areas of the country—particularly rural communities—that are facing nursing staff shortages.

A. Adoptive transfer 

B. Antibody-dependent cellular cytotoxicity 

C. Pathogen associated molecular patterns 

D. Phagocytosis 

After the Institute of Medicine’s (IOM) 2010 report on the “Future of Nursing,” the nursing field made a concerted effort to encourage current and incoming nurses to achieve higher education through a Bachelor of Science Nursing (BSN) degree or higher. As lifelong learners, nurses are committed to providing the best care possible and consistently furthering their education is part of that commitment. According to a report from AARP and the Robert Wood Johnson Foundation, 56% of U.S. nurses hold a BSN or higher, an all-time high for the profession.

Which of the Following Leads to the Greatest Percentage of Superior Vena Cava Syndrome Cases?           

A. Small cell lung cancer

B. Non-Hodgkin lymphoma

C. Non-small cell lung cancer 

D. Kaposi sarcoma                

Which of the Following Represents the Rate of Radioactive Decay Equal to One Disintegration per Second? 

A. Gray

B. Becquerel  

C. Curie

Which of the following drug spills doesn’t require a full-facepiece, chemical cartridge-type respirator or PAPR during clean up?

A. 5-Fluorouracil 

B. Cyclophosphamide 

C. Adriamycin  

D. Nitrogen mustard 

Reading is essential to growth—both professionally and personally. Unfortunately, reading for enjoyment rapidly declines after age eight, and one in four Americans say they haven’t read a book in the past 12 months.

As more U.S. states approve the use of medical cannabis, oncology advanced practice RNs (APRNs) may see increasing inquiries from patients who are interested in using it to manage cancer-related symptoms. However, the drug remains illegal under federal law, confounding research efforts for its use in cancer care and limiting the generation of supportive evidence.

I still remember what it felt like to sign my name in the chart for the first time after passing the OCN^®—and later the AOCN^®—examination: excitement, accomplishment, relief, and pride. I knew that the credential didn’t automatically make me a smarter or better clinician, but it did validate the knowledge and skills that I had been working so hard to achieve over my years of practice as an oncology nurse.

Oncology nurses seeking basic oncology certification in 2019 will need to have more experience as an RN and more hours of specialty practice before they can take an initial certification test, according to the Oncology Nursing Certification Corporation’s (ONCC’s) new eligibility criteria. The new criteria affect OCN^®, CPHON^®, CBCN^®, and BMTCN^® initial test candidates. They do not affect nurses who are renewing certification.

Which of the following is not an ONS recommendation for practice when accessing an implanted port? 

A. Sterile gloves must be worn during the procedure. 

B. Palpate the outline of the port body prior to accessing. 

C. Aspirate to confirm blood return after accessing. 

D. Use only a noncoring needle. 

Whether it’s with your smiling patient who always brings sweets to her appointments, the colleague Who started when you did, an inquisitive family member, or your supervisor, relationships are an ever-evolving component of successful oncology nursing careers. Fostering professional relationships among colleagues can often lead to mentoring opportunities that are mutually beneficial for mentors and mentees.

Oncology nurse navigators (ONNs) fill a critical, ever-growing role in cancer care settings across the country, providing patients with the resources, education, and care coordination they need to successfully navigate their cancer journey. By reducing barriers and burdens on patients and their caregivers, ONNs help lead patients from initial diagnosis, during treatment, into survivorship, and often through end-of-life care. 

Test your oncology knowledge with ONS. Which of the following is a risk factor for developing breast cancer? 

1. Women who are gravida 3 para 2
2. Mild to moderate alcohol use
3. Absence of the BRCA1 or BRCA2 mutation
4. Going through menopause prior to age 55

For sub-Saharan African (SSA) countries, cancer incidence is on the rise. The increase in cancer rates can be attributed to several factors, including economic and social development and infectious disease rates. In that part of the world, many healthcare professionals don’t have access to up-to-date information regarding safe chemotherapy handling and administration. The American Cancer Society (ACS) and Clinton Health Access Initiative (CHAI) developed the ChemoSafe program to share critical information and resource acquisition focused on safe chemotherapy administration and cancer treatments with healthcare providers in SSA. ONS provided specific nursing content to support the ChemoSafe initiative, including educational materials and courses.

With more than 50 new U.S. Food and Drug Administration approvals for cancer therapy in 2017 alone, oncology nurses are challenged about how to keep up with all of the latest practice updates. However, the Philadelphia Area Chapter of the Oncology Nursing Society (PACONS) leadership has taken an active role in helping to ensure their chapter members are given the evidence-based cancer treatment information they need to improve their practice.

Addressing a clinical problem through evidence-based practice (EBP) involves asking the right questions in the right way, finding the best available evidence, and assessing what practice change may be needed. A core factor in the EBP journey is the development of nurses who possess a spirit of inquiry within a culture that supports a systematic process for asking clinical questions.

With improved early detection guidelines and techniques as well as advancing cancer treatments, cancer is now a chronic disease in an already aging population. In addition, the Affordable Care Act expanded healthcare coverage to millions of previously uninsured Americans, increasing the need for medical services. With these trends in health care, nurse practitioners (NPs) are needed at the forefront to positively impact and enhance oncology care.

As medicinal cannabis continues to make its way into practice in states in which it has been legalized for medical use, oncology nurses, nurse practitioners, physicians, and all members of the cancer care team must be aware of the ways in which cannabis can be administered to patients. Although medicinal cannabis is still being studied, patients have several ways to use it to combat side effects like pain, nausea, and vomiting associated with cancer and its treatments. Knowing the routes of administration and the potential for drug interactions can help all oncology professionals approach medicinal cannabis in the safest possible ways for their patients.

Sepsis is a formidable complication of cancer and cancer treatment. Claiming more than 250,000 lives annually, it is a medical emergency. Do you have sepsis algorithms and protocols in place? Do all specialty areas have a way to identify patients with cancer as a highly vulnerable population? Is sepsis-specific education provided to nurses and patients? Starting the conversation and advocating for policy development and change may just save a life.

It’s beneficial to think about financial toxicity in terms of issues adhering to treatment. Mounting evidence suggests that patients with financial toxicity aren’t adhering to their cancer care. It’s becoming a common side effect of cancer treatment, and patients might be less likely to take treatments their medical team prescribes because of it, leading to substandard care.

Genetics in clinical oncology nursing practice permeates all aspects of care from prevention and detection to treatment decisions to long-term survivorship care. Each of these areas often overlap, and oncology nurses need a solid genetics understanding to provide optimal care.

Estimates suggest that 30% of all cancers are preventable through lifestyle changes and vaccinations. We know that tobacco accounts for 90% of all lung cancers and contributes to increased risk for head and neck cancers. It’s also well known that sun exposure is associated with increased incidence of basal and squamous cell skin cancers, as well as the most dangerous skin cancer, melanoma.

Earlier this month, I found this picture of my grandmother from 1918. She must have sent it to her sister, because on the back of the photo was scrawled a message: “I thought you might want a snap to see me in my nursing uniform.” This is like a selfie from nearly a hundred years ago. Although the sign behind her says, “Don’t park here,” that’s exactly what she’s doing. The humor was not lost.

The impact of professional certification goes far beyond the authority to practice. Certification is a testament to expertise, excellence in patient care, and commitment. This article uses the diverse certification journeys of three oncology nurses to highlight some of the key benefits of certification. Their paths offer direction and motivation to new and experienced nurses in this specialty.

Oncology nursing has certain universal truths: Your patients are going to need care. They’re going to need advocates, educators, and support systems to help them face their cancer diagnoses. Whether you work in a town that’s as American as apple pie or the Kingdom of Bhutan in the Eastern Himalayas, oncology nurses are at the ground level providing patient-centered care that leads to positive outcomes.