Oncology nursing: our past is the prologue ... can we author the future?

The development of the standards of care, roles in oncology nursing, and role competencies was an opportunity for Canadian nurses to revisit their professional roots, review and validate their present roles, and revise or reaffirm their future roles. The standards of care for individuals with cancer and their families affirmed the centrality of the individual and family in any nursing interaction and gave voice to the stated needs of Canadians at risk for, or living with cancer. For the first time in Canada, a specialty nursing organization has taken the lead to clearly define contemporary nursing roles and competencies. This new vision has captured the interest of oncology nurses. CANO, the nursing profession, other health care professionals, and health care decision-makers must now also consider how this enlightened view of oncology nursing can be operationalized. The presenters have had the opportunity to "hear" the stories of Canadian oncology nurses and their experiences in striving for excellence in their practice. These stories highlight the evidence supporting the standards of oncology nursing. In addition, the challenges and facilitators for achieving excellence in oncology nursing practice are identified. Through these stories, the future for the development of oncology practice and operationalization of the new standards of care emerges.     

The nursing role in radiation oncology

OBJECTIVES: To reflect on the historical evolution of radiation oncology nursing. DATA SOURCES: Published articles and texts, historical archives of professional organizations, and the authors' experience. CONCLUSIONS: The radiation oncology nursing role is multifaceted. Role components include patient assessment, patient education, support and counseling, physical care, continuity of care, research, and administrative and leadership activities. There is wide variation in staffing patterns and role implementation throughout the world, and in recent years there has been increasing interest in the development of advanced practice nursing roles in this specialized area of oncology. IMPLICATIONS FOR NURSING PRACTICE: Changes in the health care environment make it difficult to predict how the role of the nurse in radiation oncology will evolve in the future. Radiation oncology nurses will need to be proactive in developing the knowledge and skills needed to meet the challenges of the future.     

Canadian oncology nurse work environments: part II

In the aftermath of healthcare restructuring, it is important to pay attention to nurses' perceptions of workplace and professional practice factors that attract nurses and influence their retention. Continuing constraints on cancer care systems make the issue of health human resources an ongoing priority. This paper presents the findings of a follow-up study of a cohort of Canadian oncology nurses that aimed to compare nurses' perceptions of their work environment, job satisfaction and retention over a two-year period. Participants of the follow-up survey represented 65% (397/615) of the initial cohort. Many similar perceptions about the work environment were found over two years; however, at follow-up a larger proportion of nurses reported an absence of enough RNs to provide quality care and a lack of support for innovative ideas. With respect to career status, only 6% (25/397) of the follow-up sample had left oncology nursing. However, the proportion of nurses declaring an intention to leave their current job increased from 6.4% (39/615) on the initial survey to 26% (102/397) on the follow-up survey. Findings suggest that decision-makers need to use both the growing body of workplace knowledge and the input from staff nurses to implement changes that positively influence nurse recruitment and retention. Future research should focus on the implementation and evaluation of strategies that address workplace issues such as nurse staffing adequacy, leadership and organizational commitment.     

Future of the Nudrse Labor Market According to Health Execudtives in High Managed-Care Areas of the United States

Purpose :To understand how the work environment of nurses is changing in states with high enrollment in health maintenance organizations (HMOs), the underlying forces driving change, and how these forces are expected to affect employment and states with high enrollment in HMOs are generally regarded as indicative of the future for all the United States.
Design : Survey in 1995 of a convenience sample of 62 health excutives in 11 states with high enrollment in HMOs. Excutives included officals in state goverments, state and metropolitan hospital associations, professional an nonprofessional nursing associations, state boards of nursing, community and public health, home health care, nursing homes, other non-acute care associations, and leading HMOs.
Methods : Through structured telephone interviews, executives were asked about changes in nurse employment, earnings, collective bargaining, fringe benefits, nurses' roles, substitution of licensed practical nurses (LPNs) and aids for RNs, patients severity, quality of patient care, and expectations for nurse employment during the remainder of the decade.
Findings : Executives perceive a mostly and fast-changing nurse labor market but they are concerned about the aging RN work force, possible development of an RN shortage, and linking quality of patient care to the provision of nursing services. They doubt the ability of nurse educators to respond quickly to th need to prepare nurses for rapidly changing employer requirements.
Conclusions : Public and private forces are causing rapid, profound changes in health care delivery and throughout the nurse labor market. These changes are most evident in the shift in these changes, no evidence of an "employment disaster" exists it the views of health     

Canadian cancer nurses' views on recruitment and retention

bakker d., butler l., fitch m., green e., olson k. & cummings g. (2009) Journal of Nursing Management  18, 205–214
Canadian cancer nurses' views on recruitment and retention Aim The purpose of this study was to explore oncology nurses’ perceptions about recruitment and retention. Background Competition among healthcare organizations to recruit and retain qualified nurses is a real-life challenge. Focusing attention on human resource planning in oncology is highlighted by both the worsening nursing shortage and cancer incidence. Methods A participatory action research approach was used and 12 focus groups with 91 cancer nurses were conducted across Canada to collect data about strategies that could improve recruitment and retention. Results Four themes emerged reflecting oncology nurses’ beliefs and values about organizational practices that attract and retain nurses and they are as follows: (1) recognizing oncology as a specialty, (2) tacit knowledge no longer enough, (3) gratification as a retaining factor, and (4) relationship dependent on environment. Conclusions Participants highlighted leadership, recognition and professional and continuing education opportunities as critical to job satisfaction and organizational commitment. Implications for nursing management Recruitment and retention were viewed as a continuum where organizational investment begins with a well-developed orientation and ongoing mentorship to ensure knowledge development. The challenge for nurse leaders is to use the evidence generated from this study and previous studies to develop professional practice environments that facilitate the cultural changes needed to build and sustain a quality nursing workforce.     

Fostering the coexistence of caring philosophy and economics in today's health care system

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.     

The challenge facing critical care nurses in the UK: a personal perspective.

Wide-reaching professional, organisational and technological changes within healthcare have impacted on the role of the critical care nurse over the past decade. The major challenge to critical care nurses is to remain focused on providing quality care, optimistic about what can be achieved and realistic given the finite resources available. Suggestions as to how the future of critical care nursing may look are raised. Strategies to ensure that best practice and innovation continues within critical care are discussed, ensuring that patient and family needs remain a priority.     

Touched by a nurse: the imprint of exemplary oncology nursing care.

This paper examines the relationship between exemplary oncology nursing practice and professional fulfillment. What inspires nurses to choose oncology and, subsequently, what gives them impetus to continue in this field? To answer this question, oncology nurses were invited to recall moments in their careers when they were satisfied that they had chosen the "right" career. Data, in narrative form, were collected through an online research technique. Submissions were analysed using three approaches, narrative analysis (Priest, Roberts, & Woods, 2003), poetic interpretation (van Manen, 1990) and photovoice (Woolrych, 2004). Findings reveal that oncology nurses who provide excellent care, and make strong connections with their patients, are also usually very satisfied with their careers. Specifically, nurses provide exemplary care and report attaining professional fulfillment when they achieve connection with those in their care by affirming value and sharing humour. Second, caregivers feel they are making a difference when they "see patients through" the care trajectory. Nurses accomplish this in part by helping people live on, individualizing care, enabling hope, and helping individuals find meaning. It is anticipated that this paper will reawaken memories of similar experiences in caregivers, thus enhancing confidence, self-esteem and energy and reminding nurses that they do unquestionably leave an imprint.     

Career planning and development for nurses: the time has come

Developments in how the nursing profession is perceived by nurses and by society, along with unparalleled changes in health care systems, have created an environment in which individual nurses must take control of their careers and futures. Educators, employers and professional organizations also have a key role to play in fostering the career planning and development of nurses, usually the largest employee group in most health care organizations. This article provides an overview of what career planning and development is and why it is important for nurses. A career planning and development model is described that provides nurses with a focused strategy to take greater responsibility for engaging in the ongoing planning process that is crucial throughout the major stages of their career. Finally, educators, employers and professional organizations are challenged to collaborate with individual nurses on career-development activities that will enable nurses to continue to provide high-quality care in ever-changing health care systems.     

Public Health Nurses' Vision of their Future Reflects Changing Paradigms

Health care over the past decade has undergone important changes that have implications for public health nursing. The focus of public health has expanded, as a result of the World Health Organization establishing the goal of "Health for All by the Year 2000," with its strategy of primary health care. To be active participants in this expansion, public health nurses must be more explicit about their current contributions to health care systems; develop nursing frameworks consistent with the systems' changing goals; and articulate their visions of the future. It is clear that the medical paradigm of health care services needs to change to one of primary health care. Based on results of a recent public health nursing research study, a conceptual framework for the future practice of public health nursing was developed .     

Transformational partnerships in nursing education

Although the nursing care environment has changed significantly over the past 30 years, little has changed in the educational methods used to prepare new nurses. Since the 1930s, most clinical education in nursing has been structured with a faculty member supervising a small group of students on one or more inpatient units. Students usually move to new settings for each clinical rotation. This traditional model is heavily dependent on nursing faculty and often requires students to wait for direct faculty supervision. Students often are "strangers" to the registered nurses providing patient care in these settings. This arrangement can compromise the cohesiveness of the nursing team and limit opportunities for building professional relationships between students, registered nurses, and other members of the health care team. Developing a more structured and cohesive partnership between the registered nurse and the student, both of whom are providing care to the same patients, has the potential to revitalize clinical education in nursing.     

Incorporating critical care oncology nursing in a baccalaureate of science in nursing curriculum

Undergraduate nursing curricula traditionally provide a superficial overview of oncology with only a passing mention of critical care oncology concepts. With an unprecedented nursing shortage predicted in the coming decade and acute care facilities likely to overflow with an elderly, chronically ill patient population, nursing education programs must strive to assure that nursing curriculum remains relevant in the face of these future challenges and changes in health care. Rather than require employers to provide the oncology education needed by the nursing staff during the orientation period, undergraduate nursing programs must accept the commitment to provide a stronger oncology and critical care nursing knowledge base in the basic nursing curriculum. This article describes how the baccalaureate degree nursing program at Houston Baptist University accepted this challenge and incorporated content on the management of oncologic emergencies within an existing critical care nursing course. Discussion of the development of the oncology content and the benefits of incorporating the content within a critical care nursing framework are also provided.     

A living legend in pediatric oncology nursing: Jean Fergusson

Jean Fergusson is a true pioneer in pediatric oncology nursing. Her many professional accomplishments include working alongside Dr. Sidney Farber and others in the first pediatric Tumor Therapy Clinic in the United States, establishing a model pediatric nurse practitioner program that graduated an influential cadre of pediatric oncology nurse practitioners, publishing landmark papers about late sequelae of childhood cancer treatment, and serving as a role model and mentor to countless nurses over the past 50 years. Jean has brought all she is to her life as a nurse—she is gentle, funny, wise, easily moved, curious, generous, and, most of all, she truly loves children. An eyewitness to the dramatic changes in pediatric oncology over the decades, she herself is a survivor, having overcome dyslexia and other daunting life challenges. In this interview, Jean responds to questions about what shaped her interest in nursing and how she chose pediatric oncology, her impressions and recollections of the early days in pediatric oncology nursing, and her vision for the future of our specialty.     

"Towering genius disdains a beaten path" Abraham Lincoln

We see nursing leadership existing at all levels in nursing...all nurses leading. Nurse executives within academic health environments across Canada will be influencing health policy directions and dialogue within the profession nationally. They will be contributing to the development of a national agenda for nursing practice, education, research and leadership. These nurse executives will lead in a way that makes an invigorating impact on human service in health care environments and they will be dedicated to preparing the nursing leaders of tomorrow. The Academy of Canadian Executive Nurses will connect with the Office of Nursing Policy, Canadian Nurses Association, Canadian Association of University Schools of Nursing, Association of Canadian Academic Health Care Organizations and others to develop position papers regarding key issues such as patient safety, health human resource planning and leadership in the Canadian health care system. Our definition of professional nursing practice, fully integrated with education and research, will be advanced through these endeavours. The end result of a strong individual and collective voice will be improved patient outcomes supported by professional nursing practice in positive practice environments. This paper is intended to stimulate dialogue among nursing leaders in Canada, dislodge us from a long and traditional path, and place us firmly in a new millennium of leadership for the profession and practice of nursing, a style of leadership that is needed, wanted and supported by nurses and the clients we serve. It is the responsibility of those of us who lead in academic health science centres to be courageous for the students we support, the puactitioners we lead and the renewal of the profession. We are the testing ground for nursing research, and need to be the source of innovation for nursing practice. It is incumbent on us to leap forward to engage a new vision of the professional practice of nursing with a reconfigured work design and work environment compatible with the new economy, workplace and workforce.     

A conceptual framework contributing to nursing administration and research

The health care system has undergone major changes in the last decade. With greater acuity and complexity of illness, the adoption of innovative technologies and the shortage of health care personnel, the coordination and integration of health care services has become increasingly demanding for administrators. Growing dissatisfaction and concerns about safety issues are being expressed by the users of care who need to navigate through an increasingly complex system and by health care personnel who feel less efficient within the organization. Nursing administrators have a responsibility to address these issues but there is little scientific evidence to guide their actions. There are also few comprehensive models highlighting the main components of nursing administration - models that could guide nursing administration research. This paper presents a conceptual framework for nursing administration and research that links patient health care needs, nursing resources and the nursing care processes to the context of the health care system, and the social, political and cultural environments of care. A selected review of the oncology and cancer care literature is presented to demonstrate how this framework can organize existing knowledge about these concepts in the context of cancer care.     

宫颈癌患者性健康护理培训方案的构建

目的 构建针对妇科和肿瘤科护士的宫颈癌患者性健康护理培训方案,为提高其对宫颈癌患者性健康护理能力及相关临床实践提供参考。 方法 在文献检索、半结构式访谈的基础上拟订针对妇科和肿瘤科护士的宫颈癌患者性健康护理培训方案初稿。2020年9月—12月对来自北京市、天津市、上海市及吉林省4个省（市）的15名妇科肿瘤医疗专家、妇科肿瘤护理专家、健康教育专家、性科学专家进行2轮德尔菲专家函询,制订针对妇科和肿瘤科护士的宫颈癌患者性健康护理培训方案。 结果 2轮专家函询问卷的有效回收率分别为93.75%和100%,专家权威系数分别为0.843和0.853,肯德尔和谐系数分别为0.429、0.326;第2轮函询各条目的变异系数为0~0.115,满分率为20.0%~100%。最终确定的针对妇科和肿瘤科护士的宫颈癌患者性健康护理培训方案包括3个部分,其中方案内容包含6项一级指标、16项二级指标和48项三级指标;培训方式以及考核方法各6项。 结论 针对妇科和肿瘤科护士的宫颈癌患者性健康护理培训方案构建过程科学、可靠,内容专科特色明显,培训方式及考核方法形式多样,能够满足妇科和肿瘤科护士对该类患者性健康护理培训的需要,可促进性健康护理的科学及规范化发展。     

"It's what we're here for:" nurses caring for military personnel during the Persian Gulf Wars

Military nursing service during wartime represents significant contributions to a unique type of health care. The purposes of this study were to: (1) generate themes that elucidate combat nursing experiences, (2) honor nurses who served by sharing their stories, and (3) permanently archive accounts of nursing personnel who served during the Persian Gulf Wars during the late 20th and early 21st centuries. Eleven military nurses who provided health care to American troops in the Persian Gulf participated in a historical study as part of the ongoing Nurses at War oral history project documenting the experiences of nurses during times of armed conflict. The overriding theme, "It's what we're here for," demonstrates the commitment of nurses: a commitment to care and to sacrifice. Other themes drawn from the study included lessons learned from their wartime nursing experiences, sacrifices made, and chronicles of caring. During armed conflict in the Persian Gulf Wars, military nurses' personal stories demonstrated the importance of being engaged in making meaningful professional and historical contributions. These nurses displayed professional commitment and hardiness in the face of difficult life circumstances, saying, "We did what we had to do."     

The professional doctorate: rationale and characteristics.

The position that it is time for the nursing profession to develop programs leading to the N.D. degree, or professional doctorate, (for the college graduates) derives from consideration of the nature of nursing, the contributions that nurses can make to development of an exemplary health care system, and from the recognized need for nursing to emerge as a full-fledged profession. It derives from pride in the accomplishments made by nurses of the past; from discontent with the meager influence that nurses now have; and from anticipation of a future that will be created when a critical mass of nurses are provided opportunities for completing pre-service doctoral study. It derives from confidence that those nurses can and will so influence the health care system that all persons will be properly served with care that promotes their health, restores their function,, and enhances their independence in knowledgeably exploiting their own health-seeking behaviors.