Celebrating Oncology Nurses

Oncology nurses are a critical part of a cancer patient’s care team. They have the most personal interaction with the patient and provide the patient with individualized care during treatment.?

Pamela Herena, director of clinical operations at the Stanford Cancer Institute (SCI) Clinical Trials Office, oversees clinical research operations at the university level. She shared her insight into the challenges and rewards of being an oncology nurse.

The role of oncology nurses

Oncology nurses play a vast role in a patient’s care and are present at every point of cancer care. They can work in inpatient or outpatient settings, support standard-of-care treatment or clinical trials, or serve as patient navigators from referral to survivorship.

Herena says nurses look at the patient holistically and include the patient’s partners and caregivers when providing care. Pediatric nurses treat the family as a unit and prioritize them, as the family needs to be supported to best support the child.?

“Family dynamics are very important. It’s important to take care of the family so the child is cared for emotionally, as well as medically.”

Pediatric oncology nurses also understand that pediatric cancer patients are going through typical childhood development like growth spurts, and these milestones need to be taken into account when providing care. Herena notes the need for extensive communication, social work, and setting up family meetings when caring for pediatric cancer patients.

Most importantly, oncology nurses are there to support the patient however is needed. While doctors may speak with the patient for only brief periods during a hospital stay, nurses will care for patients during their entire shifts, including helping the patient with food, going to the restroom, and other activities of daily living as needed. Through this dedicated care, oncology nurses build trusting relationships with patients.

Supporting a cancer clinical trial patient

For oncology nurses who work in clinical trials, it’s exciting to be at the forefront of the next treatment or potential cancer cure. Herena explains that it’s rewarding to see patients do well on an investigational drug because the nurses know it can extend time with their loved ones and/or provide fewer side effects, which improves their quality of life.?

Oncology nurses deliver the same care to a patient undergoing treatment through a clinical trial as a patient receiving a standard-of-care treatment. However, nuances exist between the two, so clinical trials oncology nurses need to have a general understanding of clinical trials and a detailed understanding of the trial they are supporting. For example, the nurse needs to collect and document detailed information if a patient has symptoms because it could be a reportable adverse event related to the treatment being tested. If a patient is uncertain about the trial, the nurse needs to answer the patient’s questions and guide them on the next steps. Sometimes, tasks like extra blood draws and EKGs that may not be needed in a standard-of-care treatment will be required for a clinical trial.?

Herena says that the number of cancer clinical trials has increased rapidly, and nurses can be at the forefront of understanding these trials. While it’s important to have different knowledge in these instances, the care should be the same.

“The care that nurses provide clinical trial cancer patients is the same care they’d provide patients being treated with an FDA-approved drug. It's just that extra bit of clinical trials knowledge that helps nurses feel comfortable and helps them advocate for the patient, explain what they're doing, and complete all the different tasks that may come with a clinical trial.”

Improving care for cancer patients

Herena oversees the SCI’s clinical research operations and works on building efficient, seamless processes so patients enrolled in a clinical trial receive great care. She expresses that improving systems and educating nurses on better processes and procedures allows her to continue to participate in the care of patients.

“At the end of the day, it’s about providing seamless processes for the patient during their cancer journey. Healthcare is a complex system, and it’s important to have efficient processes to reduce any additional burdens for the patient.?

Nurses can work on improvement projects that identify inefficient, confusing, and/or time-intensive workflows that impede patient care. Herena notes that this is an example of nurses working together to solve problems and improve quality. These projects can involve patient care, enrolling patients in a trial, patient scheduling, and patient education processes.?

“Workflows and processes involve different departments, so issues with the workflow affect patients. This is where looking at the newest patient care model is important and helps nurses provide seamless, high-quality care.”?

Identifying gaps between clinical trials and the hospital is the first step. Herena brings up that there have been challenges regarding space limitations and scheduling patients. Leaders in both areas have been involved in working sessions to build a bridge over these gaps. By bridging these gaps, it can ensure that everyone has the opportunity to enroll in a trial and receive the same care whether being treated with an investigational drug or an FDA-approved drug.

Supporting oncology nurses

Nurses build relationships and trust with patients and their caretakers and become emotionally invested in their patients, so it can be personally difficult for nurses when the patient’s health declines or when they lose a patient. Herena explains it’s easy to see the unfairness in a patient’s situation and hard for nurses not to put themselves in their patients’ shoes, especially if they have similar life situations, such as both being mothers of small children. Emotions are more intense if the patient’s condition is severe, and it can be difficult for nurses not to take on their patients’ emotions.?

She believes that nurses have to develop their own methods to manage the emotional aspect and focus on their reasons for doing this challenging work to prevent emotional burnout. She’s known nurses who have left the profession because they can’t manage the emotional aspect.?

“Nurses aren’t immune to grief. They’re invested and often lose patients, and they carry every loss with them. The nurses that stay have a mechanism that allows them to stay, take care of themselves, and continue fighting the good fight otherwise it leads to burnout.”?

She describes her own mechanism from her bedside nursing days as visualizing adding the grief she experienced from losing a patient to what she calls “her armor,” which motivated her to fight even harder for the next patient.

It’s also important for managers and administrators to look out for oncology nurses so they continue to be well and are able to meet the demands of their job. Stanford provides resources to nurses to support them and help prevent burnout. These resources can be a meditation room to use during the workday when a nurse or other healthcare worker needs a quiet moment. Nurses can also join support groups with other healthcare workers to share their feelings on the difficulties of their jobs and explore strategies for managing the emotional aspect of caring for patients and other work-life integration strategies.?

Additionally, Stanford celebrates oncology nurses on designated days and provides them with educational opportunities that are both personally and professionally enriching. It is also important to support nurses’ involvement with organizations, such as the Oncology Nursing Society which has many opportunities for nurses to gain knowledge.?

Herena says that any time a patient is cancer-free and has concluded treatment is a time of celebration. Nurses like to share this celebration with patients by ringing bells at the end of a patient's last treatment, singing special songs, or anything that allows the nurses to celebrate with the patient. It has been a long-standing tradition for transplant patients to celebrate a second birthday on the day of their transplant, and this can be celebrated with cake, balloons, and singing happy birthday to the patient. These celebrations can be just as important for nurses as they are for patients.?

“Nurses build long-lasting relationships with patients that are often years long. People don’t understand the effects this can have on nurses. Nurses are showing up for their jobs while dealing with the negative effects of caring for cancer patients, but they show up with positive energy to support patients. The one thing I want people to realize about oncology nurses is how incredibly brave and resilient they are to do this job.”

By Katie Shumake

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