Volume 5, Issue 3

Oncology Nurses Lead From the Future

Mary M. Gullatte, PhD, RN, ANP, BC, AOCN®, FAAN
ONS President

How many times have you wondered what the future holds for you; specifically, what does the future hold for oncology nurses? We all have heard about the Institute of Medicine's report The Future of Nursing: Leading Change, Advancing Health, which was published in 2010. Four key recommendations were set forth by the committee that produced the report, which was chaired by Donna Shalala and Vice Chair Linda Burnes Bolton, PhD, RN.

  • Nurses should practice to the full extent of their education and training.
  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  • Nurses should be full partners with physicians and other healthcare professionals in redesigning health care in the United States.
  • Effective workforce planning and policy making require better data collection and information infrastructure.

Nurse leaders across the country, including American Nurses Association leaders, have embraced the committee recommendations and are developing strategies and tactics to implement the recommendations.

I am sure most of you remember the engineer, Scotty, from the Star Trek television series who beamed the crew of the USS Enterprise anywhere in time they chose to visit. What if, like the crew of the USS Enterprise, you could take a trip into the future? You are in the year 2020 attending an ONS virtual teleconference discussing the autonomy of advanced practice RNs (APRNs). Handheld devices with apps for monitoring quality indicators link outcome data to quality metrics at the fingertips. One session discusses the declining use of chemotherapy infusion centers resulting in the increased development of targeted oral agents. The number of cancer survivors has surpassed 20 million. Home care services and nontraditional symptom management clinics for new and long-term survivors are growing.

Now, come back to the present reality. In your brief glimpse, you have seen some of the advances in oncology, technology, and the healthcare future with interprofessional team partnerships as the norm in providing quality cancer care. So, what new knowledge, competencies, and skills will be required of oncology nurses to be prepared for 2020? How do you advise oncology nurses, APRNs, educators, and nurse researchers? What do you tell them about changes in practice, education, and care delivery and evidence-based interventions from research that will inform their practice to prepare them for that new, exciting, and scary future?

A healthcare future is coming that is not our current reality. Patients and families are full partners in their care. What is the role of oncology nurses in preparing them for that future? How do we engage and prepare ourselves and the next generation of oncology nurse providers across all disciplines and care settings to embrace a new reality by preparing today? How do we teach nurses to do an environmental scan and connect all the pieces to be prepared and to prepare others?

Recognizing the crucial role of nurses as partners and actively promoting positive outcomes for patients with cancer, ONS has made quality a pillar of our 2012–2016 strategic plan. In oncology, especially in the ambulatory setting, nurses serve as translators, coordinators, and navigators of care for patients and their families over the course of a disease trajectory that may fluctuate over many years. By coming to know patients' values; beliefs; preferences for learning and decision making; and knowledge level about their health and treatments, nurses will be positioned to facilitate patient-centered, high-quality cancer care in any setting.

In the future, oncology nurses will lead the transformation of the best healthcare systems that will create a national environment in which the culture, structure, and processes nurture excellence, and evidence-based safeguards are in place to protect clinicians and patients from straying from the critical paths that work. Presently, patients with cancer, especially those over age 65, represent a growing population of individuals living with more than one chronic disease and are seen by multiple members of the healthcare team in a variety of settings.

In our current fragmented system, patients are at risk for redundant, uncoordinated, ineffective, and expensive care. The risk of medical errors and additional healthcare costs increases when tests and procedures are repeated because results are unavailable to all healthcare providers managing patients' ongoing treatment. In addition, information from hospital admissions and treatments provided in other settings may not be readily available to primary or oncology care clinicians, severely limiting the ability to provide effective follow-up care and avoid unnecessary readmission to the hospital or visits to the emergency room.

In each of these examples, cancer survivors require long-term, coordinated care from multiple clinicians and community resources. The current system often does not support the adequate education of patients and families as they are discharged. This critical intervention, provided by nurses, helps patients and their families to effectively manage their disease and can help to prevent readmissions and untoward events.

Currently, challenges exist in care coordination, collaboration, and communication between providers. In many cases, medical, radiation, and surgical oncology providers view the type of care they provide as separate and sequential, rather than as part of an integrated treatment plan for patients. Further, coordination of care quality measures indicates inconsistencies in interprovider communication, even as basic as sending copies of patient visit notes to referring physician practices. In many cases, data abstractors found it difficult to locate documentation of the intended or already provided treatments from the various oncology specialties, including the date that patients completed their overall treatment plans. Leveraging technology can help to bridge the gap between patients and providers, improve interprovider communication, and facilitate access to real-time test results. Technology is another one of the ONS strategic pillars.

Quality measurement is an essential tool to improve the structures, processes, and linked outcomes across the healthcare system. Current hand-abstraction and data submission of measures, from paper or electronic records, fall primarily to nurses and are time consuming and burdensome. Efforts to align electronic health records and other systems to allow real-time, automated data collection as a byproduct of care, rather than as an additional activity, can only enhance quality efforts. As these new systems emerge, it is also critical to include measures that assess the full spectrum of care provided by all members of the team.

You have had only a glimpse of the future; how will you lead from that future? That is the challenge before each of us—to be ever mindful of the changes in our current environment that will help us to shape our future. Be a part of it.


Volume 5, Issue 3

ONS Foundation Quality Measures Project Reaches Final Phases

The multiyear grant to the ONS Foundation from the Breast Cancer Fund of the National Philanthropic Trust is moving into its final phases in late 2012. Since the grant's implementation in 2009, ONS expert project teams have developed two sets of quality measures for the care of patients with breast cancer—the Breast Cancer Care (BCC) and Breast Cancer Survivorship (BCS) sets. Pilot testing at oncology practices across the nation has yielded promising new standards of care.

BCC: This set focused on the needs of patients receiving IV chemotherapy, developing eight quality measures from ONS Putting Evidence Into Practice resources. Results revealed opportunities to enhance the consistency of symptom assessment and management. Pilot test participants indicated the need for validated assessment instruments that are more practical for routine use in busy clinical areas, as well as a desire to see this documentation incorporated into the electronic health record in a meaningful way.

BCS: This set focused on post-treatment patient care in the first year of survivorship for early-stage breast cancer. BCS measures are dedicated to the ongoing management and assessment of symptoms, as well as methods for tailoring follow-up care and education to the type of treatment received. Though measure scores were not finalized at the time of this publication, preliminary findings show multiple opportunities for continued inquiry. Results indicate the need to enhance symptom assessments and address recommendations by the Institute of Medicine's reports on survivorship. A third area of exploration is the integration of post-treatment nursing services in the absence of a formal nurse-led survivorship program.

Demonstrating the grant's broad clinical implications, as well as the enthusiasm of pilot site participants, two additional projects have grown from the research: the Quality Education project team and the Oncology Quality Collaborative (OQC).

Led by Linda Lillington, RN, DNSc, the Quality Education project team will hold 10 three-hour workshops between June and November 2012 to present "Quality Measures: From Development to Practice Change."

Workshop goals include the following.
  • Discuss the process of quality measure data collection and interpretation.
  • Simulate how to plan a practice change based on quality measurement data.
  • Identify strategies to integrate quality measurement into clinical documentation.
  • Describe how nurses can use data to make improvements in practice that optimize patient outcomes.

The OQC is a network of former pilot site participants who have formed a community of practice, discussing issues in their clinical settings related to the BCC and BCS measure sets. Monthly conference calls have examined the challenges of integrating nursing documentation into electronic health records, as well as of implementing other system assessment tools such as for psychosocial distress.

Although the group began with a focus on the BCC set, participants from BCS pilot groups recently have joined the conversation, bringing a number of new perspectives on the challenges of providing high-quality cancer survivorship care. We look forward to sharing much more news within the OQC and when the final results of the BCS measure testing become available this fall.

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Volume 5, Issue 3

ONS PEP Topics Are Staying Alive

All Putting Evidence Into Practice (PEP) topics, except for Prevention of Bleeding, currently are being updated.
All updated evidence content is being reformatted as part of the ONS comprehensive Web Site redesign. These PEP resources will be available online when this ongoing process is completed.
PEP evidence updates soon will be available via the Clinical Journal of Oncology Nursing.
Some topics will be available in monograph format; currently, monographs are available for the topics of Chemotherapy-Induced Nausea and Vomiting and Pain. These provide a single comprehensive source that includes updated categorized evidence as well as nursing assessment information. The Pain topic also includes non-pharmacologic interventions.
PEP goes international!
At the Putting Evidence Into Practice: Implementation Workshop and Project that took place on September 21 and 22 in Brussels, Belgium, the European Oncology Nursing Society provided translations of PEP evidence resources to members. PEP evidence materials spanning five topics will be translated into several languages for implementation.
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Volume 5, Issue 3

Seize the Opportunity to Partner With Nurses Around the World

Kate Shaughnessy Hankle, MBA, CVA
Manager of International and Leadership Development

Are you, or is your ONS chapter, looking for an innovative and meaningful way to make an impact on oncology nursing? Why not consider the influence you can have outside the United States? Such a tremendous need exists throughout the world for oncology education, and more and more ONS members are seeking ways to become involved with new projects and initiatives, expand their comfort zones, and play a proactive role in the transformation of cancer care on a global level.

As you consider various ways for your chapter to align its goals and initiatives with the ONS Leadership Pillar, consider the third pillar objective: "to enhance ONS's involvement in educating international leaders to promote evidence-based cancer care." Perhaps this could be a perfect opportunity for your chapter to partner with nurses outside the United States to share ideas, research, and best practices. Many ONS chapters already have connected with nurses in low-resource countries to sponsor memberships, webcourse participation, books, and even conference registrations so these nurses can obtain the training, education, and networking opportunities that ONS offers.

Thanks to the dedication and quality work put forth by ONS members, our association continually is sought after by colleagues and organizations around the world to partner on educational, leadership, and capacity-building initiatives. Most recently, the Ocean Road Medical Center in Dar es Salaam, Tanzania, has connected with ONS to determine what partnership possibilities exist for increasing the oncology education of their nurses. Ocean Road is the only cancer center in Tanzania, and patients come from surrounding countries to receive treatment there. The nurses hold diplomas, but no oncology specialization and no financial resources to train the nurses exist.

One way to work collaboratively would be for ONS chapters to connect with the nurses from Ocean Road. This could take various forms. E-mail partnerships are an easy way to discuss best practices, cultural barriers, and key aspects of cancer care. Additionally, chapters could sponsor Cancer Basics webcourse registrations, books, or other resources for several nurses.

Very importantly, ONS chapters could sponsor Congress registrations for two nurses from Ocean Road. We are hopeful that members in the Washington, DC, area would be willing to host these nurses for a week or so to attend Congress and perhaps to stay and observe practices at a local hospital.

If your chapter is interested in partnering in any capacity with a nurse or group of nurses from outside the United States, or if you are a member of a DC or surrounding area chapter and would be interested working with nurses from Ocean Road to increase their educational experiences in conjunction with ONS Congress, please e-mail Kate Shaughnessy Hankle, MBA, CVA.

Every day, we witness the many ways the world shrinks and, simultaneously, the ways that we can make a global impact on cancer care. As ONS members and oncology nursing leaders, how will you make a difference?

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Volume 5, Issue 3

SIGs Align Goals With ONS Strategic Plan

The ONS special interest groups (SIGs) updated and revised their individual SIG strategic goals during the 2012 SIG Leadership Workshop in Pittsburgh, PA.

ONS began the revision of its 2012–2016 Strategic Plan last year and now has four pillars—Knowledge, Leadership, Quality, and Technology. The SIG leadership needed to revise its goals to fit the new ONS plan—including those four pillars—to show how the SIGs can best support the work of ONS.

Please visit the SIG Virtual Community and individual SIG sites to view their new SIG strategic goals for 2012–2016.

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ONS Leadership Update is an e-newsletter published by the
Oncology Nursing Society