Life, as known on this earth, takes us on many journeys. We are unable to choose certain paths, such as those related to birth, genetics, imposed decisions, or situations beyond our control. But, we, as well as our parents, are offered innumerable opportunities to make decisions about our future that take us down known or intended paths or trails winding ubiquitous directions. At times, the journey is scary and fraught with concern about our decision making; the path may be straight and narrow, boring without desired scenery, or so steep that we choose to turn around. The path may be quite enjoyable but abruptly interrupted when outside factors change the direction beyond our control or desire.

Sometimes a bifurcation occurs in the road that provides pause in choosing our direction. While standing at the bifurcation, some decisions may seem obvious whereas others might be unknown and wieldy. And, once chosen, the bifurcation may open up to multiple additional paths, creating even more decisions or opportunities. This article will discuss the various paths, trails, bifurcations, and journeys that may be part of our nursing profession as well as our path in oncology nursing. During times of self-reflection or redirection, we may choose, or serendipitously land on various opportunities, including oncology nursing. Despite roadblocks or detours, we can thrive in our environment yet encourage our patients and their families to nurture their survival techniques.

Most nurses can recall how they traveled to their current destination and when nursing became a part of their lives. Some started their journey as a toddler playing with nursing or medical kits, followed by a straight path to science, math, and college thereafter. Others can recall the difficulty in making a college choice, let alone declaring a major, but ultimately holding a nursing degree high at graduation. And others will tell of their winding journey in adulthood that eventually led them to a nursing career. Whatever your journey, you can now walk the path of oncology nursing. The path may be comforting and fulfilling, a trail that veers a different direction, or a bifurcation that leads to exploration with new directions.

As oncology nurses, we have opportunities to stroll, sashay, run, or stop on our path. A bifurcation may appear in our journey that allows a choice, or the trail may hold roadblocks that force the direction beyond our control. At times in our lives, our own health condition or those of loved ones can direct, or possibly obstruct, our path. The birth of a child or demands of a household may necessitate finding a new trail or sharing the trail and its responsibilities with others. Financial situations may force decisions, or conditions such as Hurricane Katrina may abruptly change or end the path. Whether we pick up the speed or choose to stop is an individual decision for each person or situation. As oncology nurses, we have the ability to thrive despite changes in direction. We have the responsibility to embrace nurses facing challenges, providing guidance on their path.

For some, oncology nursing is a passion; therefore, seeking a path related to oncology is imperative and without question. In today's healthcare environment, finding a nursing job is rather easy, but obtaining a position that provides enjoyment, self-fulfillment, and inner reward may require additional networking and decision-making. When these challenges or opportunities arise, having earned a degree in nursing, such as a bachelor of science in nursing, may be beneficial. Additional education with a master's degree in nursing; degrees related to business, science, or health-related fields; or even a doctorate of philosophy may ease decision making at bifurcations, leading to unexplored, exciting paths. Nursing education provides personal and professional growth, with specialized skills and leadership capabilities. Not all oncology nurses have the opportunity to pursue advanced degrees, but we must always seek new knowledge from colleagues, peer-reviewed journals, continuing education programs, and conferences. Together, we must share our nursing knowledge and scientific findings, transforming this information into evidenced-based practice. We must continue to create new nursing science, which in turn, will ease our bifurcations, widen our paths, and lead us through winding trails.

Another facet that may ease the journey is credentialing, whether in a related nursing specialty and/or in oncology nursing. Through the Oncology Nursing Certification Corporation (ONCC) an oncology nurse can pursue certification related to practice, education, and experience (ONCC, 2005). These certifications include Oncology Certified Nurse^®, Advanced Oncology Certified Clinical Nurse Specialist, or Advanced Oncology Clinical Nurse Practitioner. Although new Advanced Oncology Certified Nurse^® credentials are no longer being given, nurses who already have this certification have the option to renew it.

Oncology nurses have the opportunity to choose a path of involvement in professional oncology-related activities, such as ONS and its local chapters. These organizations provide multiple opportunities for professional growth, as well as networking within your community and ultimately, internationally. The various activities may guide us to unknown paths and opportunities through community volunteer projects, networking, and interactions. Involvement in the American Cancer Society and cancer-related community activities such as Susan G. Komen Foundation and Race For the Cure increase the visibility of oncology nursing, thus increasing paths of opportunity.

"What Cancer Cannot Do . . .," a well-known anonymous verse related to empowerment of the patient and family against this dreaded disease, provides a brief framework for the nursing journey related to psychosocial aspects of care. Oncology nurses can significantly enrich their personal path as they teach the "cannots" of each verse in this creed: cripple love, shatter hope, corrode faith, destroy peace, kill friendship, suppress memories, silent courage, invade the soul, steal eternal life, and conquer the spirit. During moments of despair, oncology nurses can create new trails of hope in these intimate relationships unique to patients with cancer.

Susan Bauer-Wu (2005) discussed the intensity of oncology nursing with its complex treatments, stressors, changing work environment and multiple losses. She encouraged nurses to thrive in their environment, mirroring a list of characteristics noted in remarkable cancer survivors. Her prescription to be a "Nurse Thriver" included the following.

• Be self-sufficient: Have a "can-do" attitude.
• Engage in fulfilling and enjoyable activities.
• Have a supportive, trusted relationship.
• Express emotions.
• Find meaning in your work.
• Partner with patients and colleagues.
• Engage in stress-reducing activities.
• Have a spiritual connection, including nature.
• Be flexible: willing to try new things.

Although the list is a tall order for the most stable, organized, and balanced oncology nurse, it also provides a number of trails to form in your daily life. Maintaining this balance can create the environment necessary to survive in the journey of oncology nursing. Although we may choose another path in the future, something about patients and families, their disease, and their intensity to fight draws nurses to remain in this field. If you are struggling on your personal or professional path, review these points in an effort to strive and be successful. Although each person must choose their own path, ask long-term oncology nurses why they remain in the field. Many simply will say, once an oncology nurse, always an oncology nurse. May your decisions at the bifurcations lead to paths and trails that create a fulfilling, happy, and successful journey.

References

Bauer-Wu, S. (2005). Seeds of hope, blossoms of meaning. Oncology Nursing Forum, 32, 927-933.

Oncology Nursing Certification Corporation. (2005). Certification classifications. Retrieved November 12, 2005, from http://www.ons.org

Check Out the Updated Surgery List Serve

Surgery Sees 100 Years of Patient Safety

One hundred years ago, when perioperative nursing was evolving as a specialty of nursing practice, someone declared that the primary role of the operating room nurse was to protect the patient from the surgeon. Prior to 1900, Florence Nightingale had identified specific healthcare conditions and outcomes related to morbidity and mortality during the Crimean War. Even then, in the early days of aseptic and pain-free surgery, the inherent risks of invasive therapies were realized.

The practice of perioperative nursing encompasses traditional and expanded nursing activities during intraoperative care, pre- and postoperative patient education, counseling, assessment, planning, and evaluative functions. Perioperative nurses scrub, circulate, assist during surgery, monitor patients during local procedures, manage, teach, and conduct research. Nurses work in collaboration with surgeons and physician interventionalists, anesthesia providers, and other healthcare providers to plan and deliver the best course of surgical or interventional care for each patient. Perioperative nursing practice has a fundamental goal of protecting patients from injury related to numerous events, equipment, and activities such as physical hazards, extraneous objects, chemicals, electrical devices, lasers, positioning, radiation, inadvertent hypothermia, incorrect administration of medications, fluids and solutions, implants, and wrong site or wrong procedure surgery. The operating room can be a dangerous place for unprepared or unprotected patients. Providing a safe environment and protecting patients from the risks of surgical intervention is, today, as prominent a role function as 100 years ago.

Patients presenting for surgery, or even less-invasive interventional procedures, are vulnerable and anxious regardless of their diagnosis or planned procedure. Patients and families need continued education and guidance about their course of therapy, procedure, health status, and expectations for recovery and life. Anticipation of pain and postprocedure pain management is a primary concern of all patients. Patients are at risk for significant alterations in body temperature, fluid and electrolyte balance, cardiopulmonary function, and infection from the effects of surgery. Considerable risks for injury are posed by the body position that may be required for the optimum surgical approach, exposure of anatomy during long procedures, and the anesthesia necessary to maintain the patient. Nursing, in collaboration with the surgeon and anesthesia and technical care providers, bases its care on the provision of safety and protection from the potential for untoward and unintentional results of surgical intervention.

The ever-evolving technologies, increasingly complex procedures, and an aging patient population challenge surgical care providers to deliver expert clinical care in an environment of safety, and attention to the risks of the seen and unseen.

Technology Helps to Advance Surgical Oncology

Surgery always has been and continues to thrive as the primary treatment for most cancers. Since the first-recorded Egyptian papyrus documentation of intentionally manipulated anatomy and tumor removal, surgical interventions have been employed to treat, cure, diagnose, palliate, restore, reconstruct, and prevent disease. Cancer, and diagnoses related to cancer, essentially is one of the most common and significant surgical diagnoses.

As technology and scientific understanding of genetics and disease knowledge transform healthcare, developments in surgery and the implements and devices that make it possible offer less-invasive and more expedient options for treatment. Procedures typically performed in formal intraoperative environments now are available in less-invasive procedural areas on an out patient basis. Endoscopic and radiologic disciplines that formerly provided only diagnostic services now are equipped to offer interventional options, allowing patients to often avoid invasive surgery.

Cancer care has greatly benefited from such advancements and is able to offer patients many more treatment options. Nursing continues to grow and adapt with the rapid-paced changes, often struggling to keep pace with education, competency, and regulatory demands. Too often specialty nurses are underserved because of time and monetary constraints and lack of available or appropriate resources. Surgical oncology frequently takes a back seat to the proliferation of research and industry support (financial) of advancements and information on chemotherapy, radiation therapy, and biotherapy. Likewise, cancer nursing resources have less to offer surgical and interventional nurses and nonphysician clinicians than medical oncology nurses.

I believe in more focus on the specialty educational needs and support for surgical and interventional procedure nurses related to cancer treatment. I also see a need to evolve and blend, rather than continue to separate the endoscopy and interventional radiology nurses from the surgical oncology discipline. They share the same dynamic and many similar skill sets. As a perioperative educator with experience in both surgery and interventional procedure areas (not to mention being old enough to remember a time before these areas existed), I am in a unique position to influence both domains and maintain a passion to serve my nursing colleagues with what I believe I do best.

Patient Safety Is a Priority in the Surgical and Invasive Procedural Setting

Patient safety initiatives, with their redesign of existing cultures and practices, are committed to providing safe, quality patient care through preventing errors and unexpected adverse events during surgery and invasive procedures. The operating room and invasive procedural setting is a high-reliability environment, a complex system extremely vulnerable to human mistakes, where the penalty for failure is great in both human and monetary terms. These clinical areas, where safety is paramount, have been compared to an aircraft cockpit, aircraft carrier flight deck, nuclear power and chemical plant, and the space program for their reliance on human performance factor expertise (Nance, 2003). The clinical environment has evolved far beyond the limitations of individual human performance. The unique surgical and procedural environment requires all clinicians to remain alert for potential patient risks in their clinical practice and identify opportunities for creative solutions.

The Joint Commission on Accreditation of Healthcare Organization's (JCAHO's) national patient safety goals target six areas to improve safety, all of which have significant implications for the surgical and procedural settings. The goals, with their recommendations, charge us to analyze complex care delivery systems and their processes while examining human performance factors related to our specific work environments (Ebright, Patterson, & Render, 002).

The clinical environment has evolved beyond the limits of individual human performance. Error is inevitable because of limitations in normal capacity in memory, mental processing, and ability to multitask. Humans are sensitive to the negative effects of stress, fatigue, and other physiologic factors. Teamwork and social interaction processes often are flawed. Healthcare providers are trained to be perfect. Knowledge and clinical competence are synonymous with absence of mistakes (Leonard, 2003). The Institute of Medicine report, To Err is Human: Building a Safer Health System (2000), stunned the medical community and the public with statistics on numbers of medical errors and concomitant toll in terms of financial cost, pain, disability, suffering, and death. The government, healthcare industry, and public agencies have responded with initiatives to reduce medical errors, making patient safety their primary goal (Scheidt, 2002).

The Association of periOperative Registered Nurses (AORN) is a widely recognized authority on safe surgical practices, publishing recommended practices, standards and guidelines, and developing educational programs based on current research evidence. AORN's Patient Safety First program addresses practice issues unique to the surgical and invasive procedural settings. Practice areas of clinical interest include

• Medication safety
• Correct site surgery
• Infection control
• Patient positioning
• Communication
• Counts
• Blood transfusion
• Retained foreign objects
• Lack of central data repository related to morbidity and mortality
• Burns
• Fires
• Equipment failure
• Staffing

Of these clinical issues, top priorities include medication handling and administration, correct site surgery, and surgical counts (Watson, 2002). The operating room; endoscopy, minor surgery, and bronchoscopy suite; and interventional radiology department have revised and implemented new clinical guidelines to address these critical issues. Perioperative and procedural nurses play a key role in the implementation and success of these patient safety goals (Beyea, 2003).

Strategies to improve the safety and quality of patient care in all clinical domains of health care are based on understanding complex systems failure and human performance factors. The underlying principles that direct productive development of safe practices must embrace an understanding of the technical aspects of work, promoting and supporting change to a nonpunitive culture, designing systems that prevent or intercept error, and reduce reliance on memory, vigilance, calculation, and tradeoffs (Ebright et al., 2002; Groah & Killen, 2003).

Rapidly emerging technologies and trends in directed-energy modalities, which promise to make care less invasive and surgery less traumatic, present a bewildering array of new generators, probes, and accessories. These devices present significant challenges, including cost, safety to patient, equipment and staff, credentialing, and staff education. Surgical and procedural staff require comprehensive orientation plus continuing education and skill review to maintain competency (Patterson, 2003).

Patient safety endeavors in the surgical and procedural environment, guided by the JCAHO Patient Safety Goals and AORN, are directed toward overhauling dysfunctional systems, eliminating unsafe practices, and designing solutions and practical clinical applications.

References

Beyea, S.C. (2003). The National Patient Safety Goals and their implications for perioperative nurses. AORN Journal, 77, 1241-1245.

Ebright, P.R., Patterson, E.S., & Render, M.L. (2002). The new look approach to patient safety: A guide for clinical nurse specialist leadership. Clinical Nurse Specialist, 16(5), 247-253.

Groah, L.K., & Killen, A.R. (2003, March). Human factors: creating change for safer patient care. Presentation at the American Association of Perioperative Nurses Congress, Chicago, IL.

Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: Author.

Leonard, M. (2003, March). Creating and sustaining a culture of patient safety. Presentation at the American Association of Perioperative Nurses Congress, Chicago, IL.

Nance, J.D. (2003). Enhancing patient safety through teamwork solutions. Presentation at the American Association of Perioperative Nurses Congress, Chicago, IL.

Patterson, P. (2003). OR technology: Are you planning for staff training and safety for new energy modes? OR Manager, 19(6), 13-22.

Scheidt, R.C. (2002). Ensuring correct site surgery. AORN Journal, 76, 770-777.

Watson, D.S. (2002). First do no harm. AORN Journal, 76, 752-755.

Meet the Incoming Surgical Oncology SIG Coordinator

Oncology Nursing Involves Surgery at Many Levels

Patients with cancer typically undergo at least one surgical procedure at some point in their cancer trajectory. Nursing fulfills an important role in the surgical oncology care of surgical patients and their families throughout the entire cancer experience. Surgical oncology nurses can range from nononcology nurses who seldom encounter surgical patients with cancer to surgical nurses in the operating room to nurses who work solely on surgical oncology units or to advanced practice nurses in surgical oncology clinics. Surgical oncology nurses must be familiar with various cancers and the multitude of treatment options, including surgery, radiation therapy, chemotherapy, and biologic therapy. Rapidly advancing scientific and technologic methods in the surgical arena often necessitate increased nursing research, learning, and subsequent evidence-based practice changes to continue the advancement of surgical oncology nursing.

The role of surgical oncology nurses is multifaceted and ever-changing and is affected by the various members of the cancer multidisciplinary team that are caring for surgical patients with cancer. Surgical oncology nurses may be involved with patients and their families in the identification of risk factors or behaviors that prompt a preventive surgical procedure; during the initial assessment and evaluation of symptoms, surgical-related testing, and diagnosis; throughout the preoperative, perioperative, and postoperative surgical care of primary or secondary surgical procedures; in the identification and advocacy of need for surgical-implanted devices to enhance administration of therapy; for reconstructive surgical procedures during the rehabilitation phase; or in symptom identification and surgical management during the palliative phase of care. Surgical oncology nurses have the ability to exist in their own discipline to create a collaborative care environment in the prevention, diagnosis, treatment, rehabilitation, and palliation of cancer that is affecting surgical patients and their families.

So, how many different ways can we say surgery and/or surgical oncology nursing? Review your nursing career . . . somewhere, somehow, some way, surgery has probably played an important role in your own personal nursing journey and care of patients with cancer and their families.

Membership Information

• Network with colleagues in an identified subspecialty area around the country.
• Contribute articles for your SIG's newsletter.
• Participate in discussions with other SIG members.
• Contribute to the future path of the SIG.
• Share your expertise.
• Support and/or mentor a colleague.
• Receive information about the latest advancements in treatments, clinical trials, etc.
• Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
• Acquire information with a click of a mouse at http://sig.ons.wego.net, including
• Educational opportunities for your subspecialty
• Education material on practice
• Calls to action
• News impacting or affecting your specific SIG
• Newsletters
• Communiqués
• Meeting minutes.

Join a Virtual Community
A great way to stay connected to your SIG is to join its Virtual Community. It's easy to do so. All you will need to do is

• Log on to the ONS Web site (www.ons.org).
• Select "Membership" from the tabs above.
• Then, click on "Chapters, SIGs & Virtual Communities."
• Scroll down to "Special Interest Groups (SIG) Virtual Community" and click.
• Now, select "Find a SIG."
• Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
• Once the front page of your SIG's Virtual Community appears on screen, select "New User" from the top left. (This allows you to create log-in credentials.)
• Type the required information into the text fields as prompted.
• Click "Join Group" (at the bottom right of the text fields) when done.

Special Notices

• If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
• If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.

Subscribe to Your SIG's Virtual Community Discussion Forum
All members are encouraged to participate in their SIG's discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG's Virtual Community discussion forum. To do so,

• Select "Log In," located next to "New User," and enter your information.
• Next, click on the "Discussion" tab on the top right of the title bar.
• Now, select "Featured Discussion" from the left drop-down menu.
• Locate and select "Subscribe to Discussion" inside the "Featured Discussion" section.
• Go to "Subscription Options" and select "Options."
• When you have selected and entered all required criteria, you will receive a confirmation message.
• Click "Finish."
• You are now ready to begin participating in your SIG's discussion forum.

• First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
• Click on "Discussion" from the top title bar.
• Select "Featured Discussion" from the left drop-down menu.
• Click on any posted topic to view contents and post responses.

Sign Up to Receive Your SIG's Virtual Community Announcements
As an added feature, members also are able to register to receive their SIG's announcements by e-mail.

• From your SIG's Virtual Community page, locate the "Sign Up Here to Receive Your SIG's Announcements" section. This appears above the posted announcements section.
• Select the "Click Here" feature, which will take you to a link to subscribe.
• Once the "For Announcement Subscription Only" page appears on screen, select how you wish to receive your announcements.
• As individual e-mails each time a new announcement is posted
• One e-mail per day comprised of all new daily announcements posted
• Opt-out, indicating that you will frequently browse your SIG's Virtual Community page for new postings
• Enter your e-mail address.
• Click on "Next Page."
• Because you have already joined your SIG's Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click "Finish."
• This will bring up a listing of your SIG's posted announcements. Click on "My SIG's Page" to view all postings in their entirety or to conclude the registration process and begin browsing.

Surgical Oncology SIG Officers

To view past newsletters, click here.

ONS Membership/Leadership Team Contact Information

Angie Stengel, MS, CAE, Director of Membership/Leadership
astengel@ons.org
412-859-6244

Diane Scheuring, MBA, Manager of Member Services
dscheuring@ons.org
412-859-6256

Carol DeMarco, Membership/Leadership Administrative Assistant
cdemarco@ons.org
412-859-6230

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214
866-257-4ONS
412-859-6100
www.ons.org