Spring 2013, Volume 10, Issue 1  

How to Enter the Oncology Nursing Field as a New Grad: Part II

From Brazil to the United States, a Nurse’s Good Heart is the Same

The Vigilance of Oncology Nurses

As a Nurse, Caring for a Life Partner With Cancer

When Joining the Ranks of Cancer Care Feels Right

Clinical Update: A Look at the Benefits and Adverse Side Effects of Subcutaneous Velcade

A Nurse’s Place in Public Health

Applying Holistic Health Care in the Workplace

Utilize the ONS Career Center

Learn About Student Membership or Blog for ONS Connect

 

How to Enter the Oncology Nursing Field as a New Grad: Part II

Theresa Jacobs

To read part one of Theresa Jacobs’ job search recommendations, click here.

About the Author
Theresa Jacobs graduated with an Associate of Applied Science in Nursing degree from Yavapai College in Prescott, AZ in December 2012. While working as a new RN in 2013, she'll pursue her RN-BSN degree online through Northern Arizona University in 2013. Nursing is her second career and she considers herself a non-traditional student.


Explore your Nurse Residency and New Graduate RN Options

A nurse residency or new graduate RN program is a fantastic way to ease the transition from school to your first RN job in a hospital setting. Each is designed to support and encourage new graduates to more quickly develop acute care competencies. Most programs include a structured orientation period that includes didactic classroom time, psychomotor skills practice, and mentoring supervision. Studies have shown that residency programs greatly improve the retention rate and job satisfaction of nurses in their first year of employment (American Association of Colleges of Nursing, 2012).

New graduate RN jobs and residency program positions require an orientation and training period of several months to a year while working directly under a nurse supervisor. Some programs are designed to familiarize new hires with multiple areas of practice within a hospital, while others focus exclusively on one unit or specialty such as oncology (Ellis & Hartley, 2012). Medical/surgical positions may offer a rotation in an oncology unit or acute care unit that offers some oncology services; other stepping stones include critical care residency programs and pediatric intensive care.

Use search strings such as “new graduate RN” or “nurse resident” to find these programs. On hospital search boards, you’ll also discover positions for recent graduates who are eligible to take the National Council Licensure Examination (NCLEX) or who have earned their license but haven’t yet worked as an RN. Some residency programs have a formal application process, while others will require you to apply for a specific job position listed on their hospital job board for consideration. Most will require a one- or two-year commitment to the hospital after the residency is completed; look at this as the hospital’s return on its investment while giving you a fast track into a superior work environment.

Be careful to read the entire listing for eligibility requirements, as some programs are limited to BSN graduates only. Pay close attention to the permitted level of experience; most programs and positions limit acceptance to graduates with no experience working as an RN, although a few will allow recent graduates to apply if they have less than four to six months of RN experience. Most permit you to apply a few months prior to graduation and licensure and sometimes up to a year after graduation.

At the same time, “experience is preferred” for many of the critical-care-focused residencies, which usually indicates that preference is given to candidates who have worked as an LPN, CNA, hospital tech, phlebotomist, EMT or similar. Note whether the program or position requires you to be licensed in the state of application, especially if the state is not part of the RN compact licensure agreement.

Applying for a Nurse Residency or New Graduate RN

With so many outdated links and expired deadlines on the Internet, finding programs takes some effort and persistence. Start your search using the string “residency program” combined with “RN,” “nurse,” or “new grad RN.” Add the specialty area of nursing or state you prefer to work in to further narrow the results. One list of residency programs affiliated with the University Health System Consortium and the American Association of Colleges of Nursing (AACN) can be found here. You might also research the best hospital employers, starting with the U.S. News and World Report hospital rankings, which are organized by specialty as well as geographic region.

Always look for a search agent option on job boards and search engines, which allows you to receive notice by e-mail whenever new positions become available. Make your search agent specific to new graduate positions by including keywords such as “new graduate RN” or “nurse resident.” If you need more information, send an e-mail to the director of nursing education or the HR representative. Save time for both of you by briefly listing your state of residence, graduation date, and type of nursing degree, or if you’ve obtained your license, how long you’ve been working and in what nursing specialty.

Once you’ve found a residency program or new graduate RN job listing, expect a very short window of time in which to apply. If you inquire directly to the contact person for more information, many residency programs will advise you when they open up their program for applications. Have your references from your clinical instructors and your cover letter/resume finalized and ready to send before the application period opens up. Due to the very large volume of applicants that these programs receive, they limit entry quickly. Most will let you reapply, with application windows opening one or two times a year or as new job listings become available. Although it may be tempting to apply to every position that’s available, be selective and thoughtful about what you want.

A few more notes about career planning, education and certification. If you have an associate RN degree, start investigating RN-to-BSN degree programs. There is an undeniable trend toward the baccalaureate degree as the minimum educational standard and the preference of a growing number of employers. If your ultimate goal is to become a nurse practitioner or clinical nurse specialist, the AACN recommends that all entry-level nurse practitioner educational programs transition from the Master of Science in Nursing (MSN) degree to the Doctorate of Nursing Practice (DNP) degree by the year 2015.

If you already have a bachelor’s degree in any field, investigate your options for obtaining a DNP directly from your bachelor’s degree, which will require less time than pursing a master’s degree followed by a DNP. For more information about the components of master’s and doctorate programs in nursing, including RN-to-BSN and RN-to-MSN programs, I recommend the AACN’s resources on about nursing education programs and the essentials of doctoral education for nursing practice

Keep in Touch With Your Professors

Despite applying to positions all over the country, some of my best job leads came from unadvertised positions offered by local and regional hospitals who maintained active relationships with faculty at my school. My school has set up a simple Facebook page to post these job announcements for seniors and recent graduates, especially since student e-mails change after graduation.  Keep in touch with your nursing faculty or advisors and be sure they have your current e-mail address. They're the foundation to your growing network as you start your nursing career.

References

American Association of Colleges of Nursing. (2012, October 24). Fact sheet: The impact of education on nursing practice. Retrieved from http://www.aacn.nche.edu/media-relations/EdImpact.pdf

American Association of Colleges of Nursing. (2012). Nursing residency program. Retrieved from http://www.aacn.nche.edu/education-resources/nurse-residency-program

American Association of Colleges of Nursing. (2012). The UHC/AACN nurse residency program. Retrieved from http://www.aacn.nche.edu/leading-initiatives/education-resources/NRPReferenceListWithBorder.pdf

Ellis, J.R., & Hartley, C.L. (2012). Nursing in today’s world: Trends, issues, and management. (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.


Summer 2012, Volume 9, Issue 1 Students Virtual Community ONS Web site


Spring 2013, Volume 10, Issue 1


From Brazil to the United States, a Nurse’s Good Heart is the Same

Amanda de Souza Magalhães

About the Author
Amanda de Souza Magalhães will graduate from the Federal University of Rio Grande do Sul in December 2013. She spent a year as an au pair in the US and returned again in 2012 to attend the College of Nursing at the University of Massachusetts Dartmouth. After graduation, she would like to work as a registered nurse in São Paulo, which has some of Brazil’s best oncologic resources. She is considering pursuing a master’s degree in oncology.


When I entered nursing school in Porto Alegre, Brazil, my family asked me what my next goal was. I told them, “I want to see the world.” In 2012, my dream came true. I received a non-degree scholarship from the Government of Brazil to complete my senior year in Dartmouth at the University of Massachusetts.

In my second semester, I completed my senior mentorship at Saint Anne’s Hospital in Fall River, MA. Fall River is a small city in which 47% of the population describes itself as being of Portuguese ancestry. Here, my native language would be an asset, allowing me to serve as an interpreter as well as a student nurse.

I chose to work on the oncology unit because I had experienced in Brazil how patients and nurses in this field build strong relationships. My first day on the floor was exciting. I was in awe of the technology available in the United States: bar code scanning, automatic dispensing systems, a portable computer on wheels, electronic medical records. From vital sign monitors to bedside glucometers and disposable bath cloths, so much was new.

Yet despite the advanced technology, I found something in common: the nursing care. The same love, nurturing, patience and kindness exist between these two worlds. I realized that no matter how far from home I may be in the future, the way nurses care about their patients is the same.

The world is full of different cultures, but people are people and nurses are nurses. Humans experience the same fears. A nurse’s capacity to care about others is universal. 

I also believe the nurses at St. Anne’s learned about Brazilian culture as we compared our two healthcare systems. The Brazilian system provides free primary care, surgery, and medication. Despite the human resources and infrastructure problems, there is a permanent cultural belief that everyone should contribute to health care because it is a right. Americans have state-of-the-art facilities, but the country still has a lot of people who don’t have health insurance and growing healthcare costs.

My experience will serve as a guide for the rest of my life as a nurse. I will bring home luggage filled not just with brand new electronics and books, but also a high-quality nursing education. I want to be an oncology nurse to stand by patients facing the unknown in the beginning or going through the challenges of treatment. Regardless of whether the goal is cure or comfort at the end of life, I’ll be there with them.

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Spring 2013, Volume 10, Issue 1 


The Vigilance of Oncology Nurses

Jennifer Boll

About the Author
Jennifer Boll is a senior at Illinois Wesleyan University who is working towards a dual degree in Nursing and Hispanic Studies. She holds membership in the Oncology Nursing Society and Sigma Theta Tau International Honor Society of Nursing. Her clinical experience includes work in the United States and Barcelona, Spain. Boll is pursuing a rewarding career in the oncology nursing profession.


One of the defining traits of oncology nurses is vigilance—that knowledgeable watchfulness that occurs in response to threats. My understanding of vigilance began during an undergraduate psychiatric/mental health rotation, where I’d taken a piece of paper from a patient who had earlier tried to cut herself with it.

My professor, who had watched the encounter, told me that being willing to be assertive and advocate for patients added up to vigilance—a quality that she thought would make me a great oncology nurse. Her research had indicated that oncology nurses purposely connect with patients and families to enhance their ability to become more effectively vigilant. When they know patients and their families on a more personal level, they can spot abnormal behavior and respond more quickly to threats.

When I was interviewing for summer internships in oncology, nurse managers spoke of their strong patient-nurse relationships and the protection they give their patients, especially when rotating physicians come to the unit. Oncology nurses form extremely close bonds with patients and caregivers and feel a duty to advocate for them.

I saw the connections between hope and vigilance when I shadowed on the pediatric oncology floor of a St. Jude Children’s Hospital affiliate in Peoria, IL. The nurses there were overtly attentive to their patients; on one child’s final day of treatment for acute lymphocytic leukemia, they wore his favorite scrubs and baked his favorite treats to celebrate.

It was inspiring to see the hope that filled the room because of the nurses’ passion for what they did and for who they helped. As my professor’s research has found, instilling and having hope are integral parts of vigilance in oncology. When hope is lacking, people are not as vigilant.

It seems that the qualities of vigilance are deeply ingrained in oncology nursing. Perhaps it is these qualities that draw people to oncology, with this quality further developing over time. For me, recognizing my own qualities of vigilance and patient-centeredness has directed me toward a future career in oncology nursing.  

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Spring 2013, Volume 10, Issue 1 


As a Nurse, Caring for a Life Partner With Cancer

Al Farrell

About the Author
Al Farrell graduated from Pace University’s accelerated BSN program in August 2012. Prior to nursing, he used his journalism degree and MBA to run an executive recruiting company that placed candidates across the US and Canada. He lives in northern New Jersey and recently welcomed his first grandchild. Farrell is passionate about oncology nursing, cardiology, and critical care, and is actively looking for his first position as a new nurse in the greater New York area.


It was a cold fall morning in 2010 as I began my first full day of clinical rotations at the Manhattan VA Hospital as a first-year nursing student. Money was tight. My successful 12-year business had gone down the tubes. Family, friends, neighbors—everyone knew I was a man with five kids starting over.

I headed into the VA, recognizing a couple of my classmates sipping coffee and exchanging nervous banter.  I gladly joined them, not knowing that soon, everything would change. Oh, part of me knew, but denial is a strong force and men are talented at putting things into little compartments. I was focused: day 1 of clinical.

About 10 days earlier, my wife and I had discovered a large lump on her breast that appeared overnight.  A biopsy confirmed that it was a 9-cm malignant tumor with at least one lymph node affected. We met with a top oncologist and a breast surgeon the next day, opting for a double mastectomy with reconstructive surgery a year later. “Does that mean I get a free tummy tuck with that?” asked my wife. The surgeon was cracking up. We had been through a lot in our lives; we could do this.

Back at the VA, my morning went smoothly. I gave my first intramuscular injection, helped a patient’s family plan palliative home care, and gave mid-shift report to the RN in charge.

Then my cell phone rang.

Jokes were gone; the news was bad. Scan results showed multiple tumors in the spine and pelvis. Mastectomy was cancelled: welcome to Stage IV. The room started spinning and tears welled up in my eyes. What now? Quit nursing school? Take a leave of absence?

After the initial shock, I received a lot of advice, with some urging me to keep going in the one-year program. Summer would arrive before I realized it, they said. I listened; I agonized. Being career-focused is a strongly accepted value, especially in men. But plowing ahead was akin to patient abandonment. And this patient was my life partner!

With compassion and practicality, my program directors offered a way: they pulled all the strings to retroactively put me in their two-year program. I could be genuine, fully present for my wife and family, and continue with my own growth and development in becoming a nurse.

The next 20 months were the most challenging—and most amazing—of my life. Nursing school was grueling, with late nights and 4-am mornings being the norm. I loved each moment, but it was an endurance test.

I also had my own rotations with my wife at Hackensack University Medical Center. I became intimately familiar with tumor grading and staging, hormone therapy as a neo-adjuvant treatment to shrink tumors, surgery and post-operative recovery, and of course, the 26-week ordeal of chemotherapy and radiation.

Perhaps from sensitivity, Pace didn’t assign me to an oncology floor rotation. But when my wife nearly succumbed to pneumonia from a neutropenic emergency during chemotherapy, I was with her round-the-clock for almost a week on an acute oncology floor. My professional and personal life—and learning curve—intermingled constantly.

Through it all, my inspired me and everyone around her. The world of oncology became our world.  We acquired a new “family” in the form of caregivers, patients and their relatives as well. I began to appreciate the unique depth and closeness that comes with joining the club no one wants to be a member of. I sensed it was there that I wanted to give back as a nurse.

As I joyfully approached graduation in August of 2012, my wife’s prognosis gave us much hope and optimism: all scans showed her cancer-free. Her oncologist called it miraculous. Stage IV doesn’t use the term remission, but for now, a major battle had been won. As for me, I accompanied my wife for her remaining daily treatments in the fall, then passed the National Council Licensure Examination in December.

More than two challenging years later, my wife remains stable. We strive to make each day meaningful. Thus far, ongoing treatments are working, and each day is a gift. This, too, is part of my formation as a nurse.

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Spring 2013, Volume 10, Issue 1 


When Joining the Ranks of Cancer Care Feels Right

Meredith Curtis

About the Author
Meredith Curtis is completing her first year as a second-degree nursing student at MGH Institute of Health Professions in Boston, MA. She has a B.A. in economics from Brown University and worked two years for Epic Systems. She is currently a medical assistant at the Dana-Farber Cancer Institute in Boston, MA. Meredith hopes to work as an infusion nurse and as an oncology nurse practitioner in New England following her graduation.


I was late to the lecture that would have a profound effect on my career. When I arrived, an alumnus of my second-degree nursing program was describing his role as a nurse practitioner in managing oncologic emergencies like tumor lysis syndrome, severe neutropenia, and spinal cord compression. The more I listened to the steps he took to make unplanned admissions smoother, the more the daily work of an oncology nurse came into focus as a possibility for me.

Until then, I had pictured myself vaguely in a medical-surgical nursing role, though I had an interest in palliative care. I was fascinated. I could see myself challenged and fitting well within a specialty that requires a finely-tuned repertoire of treatments, an understanding of the individual patient’s experiences and needs, and a focus on advocating for each person’s definition of quality of life. Intellectually, cancer care attracted me for its commitment to progress and nearly universal popular hope for continued improvement in prognosis and symptom management quality.

In light of the loss of my dad to pancreatic cancer, cancer care also had a personal resonance for me. This felt right. My dad had taught me many things, from driving a stick-shift car to hooking up a programmable thermostat. I continue to learn from my experiences as his daughter as I am drawn to becoming an oncology nurse, and ultimately, a nurse practitioner.

At the conclusion of the lecture, I waited my turn to talk to the presenter and asked for more details about his career path. I would eventually spend two days shadowing him and realizing how much I still had to learn. He made communication seem effortless; on one of those days, we worked with an interpreter and a patient with extensive jaw damage who was most comfortable writing her questions and having them translated. His clear explanations to patients inspired trust.

With my new appreciation for the daily work of oncology nursing, I feel a renewed sense of purpose in class and during my clinical placements. Putting patients’ priorities for quality of life first is relevant in all patient care situations. When I research treatment decisions and why a choice was or wasn’t the right one for an individual patient, I dig deeper now.

If I could pass anything on to other nursing students, it would be to regularly reflect on what you find meaningful about nursing and to keep revisiting your goals. Actively seek out a mentor who allows you to explore them. This brought my purpose and career plans into greater focus and confirmed that there was a place within nursing that was right for me.

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Spring 2013, Volume 10, Issue 1 


Clinical Update: A Look at the Benefits and Adverse Side Effects of Subcutaneous Velcade

Casey Bayliss

About the Author
Casey Bayliss is a 2010 graduate of the BSN program at East Tennessee State University. She is currently working as a registered nurse on the Adult Blood and Marrow Transplant unit at Duke University Hospital in Durham, NC. Bayliss is enrolled in the MSN program at Duke University, with plans to complete her MSN/oncology nurse practitioner degree in May 2014.


In January 2012, Velcade (bortezomib) was approved for subcutaneous administration, which has improved the quality of life for patients with multiple myeloma. Although the response rates from intravenous Velcade are excellent, its side effects have often limited administration, particularly for patients with poor venous access or those at high risk for peripheral neuropathy.

Benefits
In addition to eliminating the need for venous access and shortening clinic time, subcutaneous Velcade has several other reported benefits. Gastrointestinal toxicities have decreased when compared to intravenous administration, with patients reporting that the treatment has also decreased stiffness, nausea, and fatigue. Subcutaneous Velcade continues to have peripheral neuropathy as a side effect, but has greatly decreased the dose-limiting toxicities of intravenous Velcade.

Adverse Effects
Reported adverse effects include thrombocytopenia, neutropenia, and anemia, which should be monitored with standard lab draws. Patients may also experience redness at the injection site. Because Velcade has the potential to interact with foods and beverages, remind your patients that St. John’s Wort, green tea and green tea extracts, and ascorbic acid can decrease Velcade levels. Grapefruit can increase Velcade levels.

Administration
Velcade must be administered in the abdomen or thighs, and injection sites should be rotated at least one inch from an old site. They should not occur where skin is tender, bruised, indurated, or erythematous. Velcade should not be administered to any patient with a history of hypersensitivity to bortezomib or Mannitol, and should never be administered intrathecally.

Blood glucose levels should be monitored closely in diabetic patients, especially those on oral hypoglycemic agents, as Velcade can alter the effects of the hypoglycemic agents. Caution should be used with administration of certain antidepressants, proton pump inhibitors, Warfarin, and anti-epileptics, as these levels could be altered with Velcade administration.

Subcutaneous Velcade has already helped to improve the lifestyle and treatment process for patients with multiple myeloma. With the advantageous change in administration route of this already established and effective drug, patients are living with less side effects and continuing to fight the battle against cancer.

Reference
Millennium Pharmaceuticals, Inc. (2013.) Velcade (bortezomib) for Injection. Retrieved from http://www.Velcade-hcp.com.

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Spring 2013, Volume 10, Issue 1 


A Nurse’s Place in Public Health

Maureen Mahon

About the Author
Maureen Mahon is a junior in the Saint Louis University School of Nursing. She has been involved with the Epilepsy Foundation since her sophomore year of high school, including serving as president for the local youth council chapter, attending the Public Policy Institute, and lobbying for state and national legislation. She is currently a member of the Epilepsy Foundation’s National Center for Project Access advisory board. Mahon hopes to graduate in 2014 and to continue her studies toward a doctorate in nursing, focusing on the care of those living with chronic illnesses.


I was diagnosed with epilepsy in the seventh grade, and throughout high school, I’ve been involved with patient advocacy through the Epilepsy Foundation. I’ve assisted with fundraising, helped to advocate for policy change on the national and state level, and mentored others who have received similar diagnoses as mine.

As I continue to volunteer throughout my undergraduate nursing studies, my role with the Epilepsy Foundation has evolved. I can now provide not only the personal experience of a person living with epilepsy, but also the beginning role of an educator and advocate who utilizes nursing knowledge. I have begun to see how nurses in public health roles can be change agents for entire populations.

Public health exits the comfort of the hospital setting, with all of its advanced equipment and quality-controlled environment. It goes to the heart of society and looks for issues that are impeding the health of not one, but many people. As lobbyists, board members, program developers, and nonprofit organization leaders, nurses can testify to the needs of patients who they have worked alongside in practice. Based on their knowledge of the needs and disparities within a community, they help to influence how an organization distributes its funds and programs.

Whether they’re in the inpatient or outpatient setting, practicing nurses recognize modifications that could be made which would benefit an entire community. Nurses should challenge themselves to embrace and implement these interventions, locating an organization or even starting their own to begin to make these changes.

Public policy and advocacy roles offer many trials and challenges, including lack of funding, support, and often protocol. However, the long-term benefits can potentially promote preventive health and improved quality-of-life initiatives, decreasing the occurrence and consequences of illness and disease.

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Spring 2013, Volume 10, Issue 1 


Applying Holistic Health Care in the Workplace

Allison Gilmore, Emma Kaizer, Blake Roach, Samantha Buffalini, Katie Elliot, and Marguerite Dickenson

About the Authors
Allison Gilmore, Emma Kaizer, Blake Roach, Samantha Buffalini, Katie Elliot, and Marguerite Dickenson are sophomore nursing students in the Southside Clinical Group in Pittsburgh, PA. Their goal this semester has been to understand human growth and development from a holistic perspective and to apply these principles in a clinical setting. They will graduate in the spring of 2015 from the Duquesne University School of Nursing.


After experiencing the benefits of meditation firsthand in nursing school, we applied what we’d learned about complementary and alternative medicine (CAM) to several clinical experiences at nursing homes, the Allegheny County Jail, and the Curtiss-Wright Corporation, a manufacturing facility in Cheswick, PA. No matter where we went, we found that each setting stood to benefit from more innovative, non-traditional ways to manage daily health challenges and cancer symptoms.

At the Curtiss-Wright Corporation, we were accompanied by a holistic nurse practitioner who led the group of middle-aged factory employees through guided meditation. At the beginning of the meditation, many of the employees were skeptical as to how the experience would benefit them. We explained that it could not only promote relaxation in the workplace, but also improve their health on a daily basis and with more long-term illnesses.

Feedback was positive, with the employees indicating that their stress levels had fallen as a result of this technique. In fact, one factory worker who was a cancer survivor said that she wished that this method had been available to her during her treatment. Many of the employees reported later that they’d been lessening their stress and pain on a daily basis using CDs of the guided meditation that we’d brought. The nurse at the manufacturing facility was even using guided meditation to help employees who suffered from migraines.

As the United States becomes more culturally diverse, it is important that we become more open to practicing holistic remedies that other cultures have utilized for thousands of years. Studies show that approximately 83% of patients with cancer utilize at least one holistic integrative modality, and we now have this tool to offer to our patients in the future (Chilkov, 2011). By incorporating holistic practices in their lives, those suffering from chronic illnesses can reduce pain and suffering in their experiences.

Reference
Chilkov, Nalini. (2011, March 23).  Why 80% of Cancer Patients Use Integrative Medicine. Retrieved from http://acam.typepad.com/blog/2011/03/why-80-of-cancer-patients-use-integrative-medicine.html     

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Spring 2013, Volume 10, Issue 1  


Utilize the ONS Career Center

Looking for help constructing your resume or curriculum vitae? Interested in interviewing tips? Want to know more about finding a job through the ONS website?

Learn more!

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Spring 2013, Volume 10, Issue 1  


Learn About Student Membership or Blog for ONS Connect

Do you have questions about your ONS membership? Would you like to become a member, or hear about ways that you can get more involved in ONS activities? We look forward to hearing from you at membership@ons.org.

ONS Connect, the official news magazine of ONS, is also seeking new blogging contributions from recent nursing school graduates or early career professionals. For more information about how to become a guest blogger, please contact mmckrell@ons.org.

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