As use of ambulatory care settings continues to grow, so too does the demand for expertly trained nurses to staff them. Unfortunately, nurse staffing levels have struggled to meet the burgeoning need in ambulatory clinics throughout the country. Traditionally, undergraduates receive limited ambulatory-specific education in nursing school, leaving them unprepared to enter those settings after graduation. However, the nursing shortage complicates staffing issues, and we must develop programs to direct new graduate nurses into ambulatory oncology careers.  

During the Year of the Nurse, many organizations are finding ways to promote and champion the expertise and experiences that make up the most trusted profession in the United States. The American Association of Colleges of Nursing (AACN) is focusing on ways nurses will affect the upcoming presidential election, ensuring nursing professionals are registered, educated, and ready to vote in 2020.

Only 65% of all U.S. teens have received the first dose of the human papillomavirus (HPV) vaccine—and only 48.6% of those teens are up to date with the series of HPV vaccinations. Studies have shown the HPV vaccination is effective at reducing the rates of cervix, vaginal, anal, and penile cancers. HPV vaccination rates have become a national health prevention priority, and oncology nurses can help lead the discussion about ways to prevent more than 90% of all HPV-related cancers.

Each year, February marks Black History Month: a time of celebration, recognition, and awareness of the countless accomplishments and achievements of black leaders and trailblazers throughout history. In the oncology nursing community, it’s no different. ONS’s African American leaders have made a lasting difference to patients with cancer and the professional community, paving the way for future generations and championing excellence in oncology nursing.

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.

ONS member Donna Clark, RN, BSN, OCN®, was a dedicated oncology nurse whose impact changed the lives of countless patients with cancer for more than 30 years. Clark passed away on February 4, 2020, after a storied career as an oncology nurse and cancer survivor. Her experiences as both patient and healthcare professional allowed her to cross the gap, relate to patients, and empathize with their cancer journey. Her focus on nursing excellence left a lasting impact on the profession and resonates throughout the larger oncology nursing community.

Although cancer biosimilars have been used in European countries and in U.S. supportive care for some time, biologic medications are still new to cancer treatment in the United States. With greater support coming in at the federal level and from agencies like the U.S. Food and Drug Administration (FDA) and Federal Trade Commission, the rising biosimilar tide could soon reach a new highwater mark for healthcare professionals—and nurses specifically.

The Woodhull Study on Nurses and the Media: Health Care’s Invisible Partner  showed that nurses were quoted in only 4% of health stories in the news media. In 2018, Mason and team published the Woodhull Study Revisited: Nurses’ Representation in Health News Media 20 Years Later. They found that after two decades, only 2% of health stories in the news media quoted nurses; although not statistically significant, the decrease is still a concern. The 1998 study identified that nurses were just starting to move into positions of authority in healthcare systems, a status that might make them more available for journalists. Yet in 2018, nurses occupied more healthcare leadership positions in diverse sectors but were still not being used as expert sources by journalists. Why?

More than engineers, accountants, professors, or police officers, nurses lead the pack when it comes to honesty and ethics, according to 2019 Gallup polling data. For 18 years in a row, nurses have been recognized as the most trusted profession in the United States—by a considerable margin, too. Ratings for nursing honesty and ethics outpaced every other profession by a wide margin, and nurses lead the next most trusted profession—engineers—by nearly 20 percentage points.

In celebration and recognition of Florence Nightingale’s 200^th birthday, the World Health Organization (WHO) designated 2020 as the “Year of the Nurse and Midwife.” As part of this initiative, WHO is holding seminars, publishing papers, and is developing the first-ever State of the World’s Nursing report which will release at the 73rd World Health Assembly.

Issues pertaining to geography, socioeconomic status, or racial or ethnic background can prohibit patients from accessing the treatment and care they need to successfully navigate their cancer diagnosis. Connecting patients to healthcare professionals and tailored interventions that educate, motivate, and reduce barriers can be a tremendous boon for their care and ultimately their outcomes.

Celebrations are planned around the globe for 2020 to recognize the impact that nurses make on the health and well-being of our communities. What’s the occasion? The World Health Organization has designated it the Year of the Nurse and Midwife, in honor of Florence Nightingale’s 200th birthday. This exciting year will culminate with the end of the three-year, international Nursing Now! campaign designed to raise the profile and status of nurses worldwide. And we’ll look forward to the release of the new Future of Nursing 2020–2030 consensus study from the National Academy of Medicine that will describe how nurses can help people to get and stay healthy.

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.

“An investment in knowledge pays the best interest,” Benjamin Franklin wrote. for oncology nurses and their patients, this couldn’t be more apt. Patient education is critical throughout the cancer journey, and nurses are essential to individualizing that education.

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.

As part of the rigorous process of transitioning ONS Putting Evidence Into Practice recommendations into formal, actionable clinical practice guidelines, the draft guidelines must undergo a public comment period. The first five guidelines to reach that step will be open for public comment in December 2019 and early 2020.

One constant in nursing practice is time and how nurses never have enough of it. Between a full schedule of patient visits, consulting with coworkers, administering treatments, and the myriad other responsibilities filling a nurse’s day, nurses can struggle to address all of a patient's concerns in the time leftover. Nurses must be adept at balancing their time and multitasking in their duties.

A few weeks ago, a former student who was returning to the Pittsburgh area six years after graduation invited me to lunch. She had completed a master’s degree in the interim and had worked successfully as a nurse practitioner.

Since the National Academies of Medicine (formerly the Institute of Medicine) issued Cancer Patient to Cancer Survivor: Lost in Transition in 2005, the oncology field has made small strides to implement successful survivorship resources to support patients after their treatment. Because of the vast differences in patient populations, disease types, study locations, and institutional resources, best practices to support patients transitioning from treatment to survivorship care are often unclear. This poses an issue for providers, and patients hear mixed messaging or little information for follow-up care. With many patients receiving treatment in outpatient settings, ambulatory oncology nurses must understand how to provide support for patients during their transition.

At a recent conference I attended, a presenter asked the audience to choose the best treatment option for a case study review. The choices were introduced as three separate viable treatments with the fourth option being “or just refer to palliative care.”

As a unit staff nurse, have you ever thought, “I wish they would’ve asked my opinion before making that change in practice?” Many times throughout my career I’ve thought just that, but I’d never been in a position where I could share my opinions. However, getting involved in a shared decision making (SDM) structure opened up new opportunities for me. 

While looking for an image for a presentation, I came across this quote on a picture of a woman whose hands were more than full. It captured the message I was going to be giving. The world of health care, specifically cancer care, continues to evolve rapidly from an array of forces outside of our control. However, in that swirl of change, we have the opportunity to evaluate any resulting barriers or challenges to patient care and to design and implement solutions. To do this, to be creative, to innovate, to problem solve, we may have to let go of things with which we are comfortable but are not of benefit in today’s world.

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.

I remember my first day as a student nurse technician at an academic medical center as if it was yesterday. It was a Saturday afternoon shift in May 1996 on 10 Green at Harper Hospital in Detroit, MI, on a hematology unit that cared for patients with either malignant hematology (i.e., leukemia and lymphoma) or benign hematology conditions (e.g., sickle cell disease).

Dylan sat on the plastic chair with his elbows rested on his knees, staring blankly at the white tile floor in the clinic exam room. He was listening to me talk about the side effects of chemotherapy, but I could tell he had more on his mind. He lifted his head and touched his red baseball cap with his left hand.

“This is a lot to take in,” he said in a befuddled tone.

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.

One word comes to mind to describe the 2019 ONS Chapter Leadership Weekend (CLW): exhilarating. As a chapter Board member attending for the first time, I learned new information, networked and met with dedicated chapter leaders, and of course got to eat some delicious food while in Pittsburgh.

Achieving Magnet recognition is the gold standard of a nursing program, demonstrating that an organization’s nursing leaders have established nursing excellence to improve outcomes for patients. And now the results of a new study published in Harvard Business Review show that excellent nurses are positively linked to physicians’ performance as well.

The World Health Organization designated 2020 internationally as the Year of the Nurse and Midwife in honor of Florence Nightingale’s 200th birthday. To celebrate the work that nurses do globally, nursing organizations around the world are creating programs that offer recognition—as well as education, training, and professional development.

Finding comfort among loved ones at home can be conducive to healing in all of its dimensions for patients with cancer. For patients in home care, many aspects of treatment and day-to-day medical care are done by loved ones or family members. In the United States, nearly 4.6 million at-home caregivers are tending to patients with cancer. Although many at-home caregivers embrace the responsibility, managing successful oncology care can be a complex burden for family members—many of whom are likely unprepared for the stressors of cancer care.  

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.