WASHINGTON-"Everybody up," Oncology Nursing Society President Mary Gullatte, PhD, RN, ANP, BC, AOCN, FAAN, said here during the opening session of the Society's 38th Annual Congress. She had asked all the nurses who saw themselves as emerging nurse leaders to stand. "I still see some of you folks sitting," she said. "That really was a trick question because all of you are leaders-everybody up."
Getting up and getting engaged was the charge Gullatte gave to the more than 3,500 nurses in attendance: "Prepare yourself for the future-whatever it may look like. What role will you have in creating and shaping and thriving in that future state?"
The "ever-increasing" workforce shortage, heightened competition for dwindling research dollars, growing use of targeted therapies for personalized medicine, and the demand for more efficient models of health care were some of the challenges she noted that would require more leadership among nurses than ever before to maintain and improve patient care. And for the next four days, speakers and members-during keynote lectures, podium sessions, and in conversation-challenged each other with new opportunities to lead.
Embrace Health IT
"No one is going to be advocating for patient engagement and patient decision-making if we don't," said keynote speaker Judy Murphy, RN, FACMI, FHIMSS, FAAN, Deputy National Coordinator for Programs and Policy in the Office of the National Coordinator for Health Information and Technology at the Department of Health and Human Services, addressing the membership after Gullatte's opening welcome. "We own this space. We've had the patient advocacy role forever. We've been the foot soldiers."
Murphy's lecture, "The Role of Health IT in Healthcare Transformation," was about how embracing new technology will lead to improved care-and better patient outcomes.
E-prescribing will help decrease pharmacy errors, she said. Electronic medical records will make it easier for physicians to communicate with each other-facilitating the easier sharing of patients' medical histories.
Health information technology supports the goals of improving the quality of patient care, she said. "We're the ones who need to have these crucial conversations with patients to encourage them to use patient portals, to sign up for electronic medical records, and to really start seeing how they can take control of their own lives-whether it's disease management or health promotion and prevention."
Murphy highlighted the meaningful use program, which was part of the government's stimulus package (the 2009 American Recovery and Reinvestment Act). Stage one was getting electronic medical records in place, and now in stage two, it's making sure the systems can "talk" to each other, she said.
"We're looking at the infrastructure-better health care, better health, and reducing costs. It's not just helping us manage individual encounters. It's actually creating the infrastructure so we can become a learning health organization."
Patient-centered care is about engaging patients and emphasizing to them the need to share responsibility for their care, she said-adding that patients will need to be familiar with the information in their health records. "We need to help pull our patients into the 21st century. If you're looking for an opportunity to lead, this is it."
One of the key priorities in health care today is to move toward patient-centered care-and technology can help with that-"it can't make the change, but it can help. Health information technology is the means not the end."
Improve Patient-Centered Care
What does patient-centered care look like in 2013, Donna L. Berry, MSN, PhD, RN, AOCN, FAAN, asked during this year's Mara Mogensen Flaherty Memorial Lecture. "It's about using technology."
Her talk, "The Patient's Voice: Are We Hard of Hearing?," was about Berry's evidence-based project, the Electronic Self Report Symptom Assessment-Cancer (ESRA-C). Her team developed a web-based model that allowed a group of cancer patients to log symptoms and personal concerns during the time between visits and at four separate visits. The patients logged in over a secure server and filled out a cancer type-specific questionnaire that they could annotate with additional personal comments.
During recorded clinic visits, symptoms like pain, fatigue, and nausea got the most attention, while questions about sexual activity, emotional distress, or sleep disturbances, received the least attention, she said.
The takeaway: "Patient-centered care requires action that is truly focused on patients' needs and preferences. To know those, one must have a validated approach to inquiring, which very few places do-and administrators assume they know what the patients' needs and preferences are."
When patients used the self-assessment tool, symptom distress was significantly reduced, especially in patients over age 50, she said. The tool not only facilitated more personalized care, but also encouraged self-care. The point of the project is to create opportunities and the environment to let patients focus on patient-centered care. "It's about finding what doesn't get addressed for our patients to improve symptom quality of life."
The bottom line: "Create the opportunity and the environment to let patients focus on patient-centered care."
Lead Through Advocacy
Other sessions at this year's Congress covered new and updated screening guidelines and recommendations, how the Affordable Care Act affects oncology nursing (see page 6), and oncology drug shortages.
These sessions represent our current health care environment, said Joni Watson, MBA, MSN, RN, OCN, Clinical Nurse Manager in Oncology Services at Seton Healthcare Family in Texas, who served as Chair of the Planning Team for Congress this year.
"We can't sit on the sidelines anymore. These policy issues are relevant for nurses in all levels of leadership," she added in a follow-up email.
Oncology nurses are patient advocates, said Myra Davis-Alton, RN, MSN/Ed, OCN, CRNI, an oncology nurse for the Department of Veterans Affairs in Las Vegas, who co-moderated the session on oncology drug shortages.
The key message to nurses during that session, she said: "Advocate for policies that define possible drug shortages and explain how to deal with them-facility practice standards, ethics committees, consortiums. We need a plan because this isn't going away."
During the "Cancer Screening Guidelines Clarity and Controversy" session, speaker Joanne Ebner, RN, TTS, a cancer prevention nurse at Anne Arundel Medical Center in Annapolis, Md., put the onus on nurses to educate themselves: "Patients come to us for recommendations, so it's important that we have the knowledge," she said. "Be educated so we can educate our patients and the public to provide that consistent message and quality care in screening."
An audience member at the session on the Affordable Care Act took the microphone during the question-and-answer period to talk about the ONS-sponsored House of Representatives bill 1661, introduced in Congress in April. If passed the proposed legislation would amend the Social Security Act to provide more comprehensive cancer patient treatment education for Medicare patients and expand cancer symptom management research (http://www.govtrack.us/congress/bills/113/hr1661/text).
"This is something we need to get behind," he said. "When we all go back to our communities, wherever that might be, we need to go back to our federal legislators and ask them to support this."
Oncology nurses are vital to patient advocacy, Watson explained. "We have a tremendous amount of untapped potential within our entire profession. Patient advocacy is a nursing role most nurses guard and take pride in. Patient advocacy takes place in government buildings, and oncology nurses should be present."
Envision the Future
Before leaving the stage during the Opening Ceremonies, Gullatte asked everyone in the audience to pick up a journal that would be handed out at the exits. "I want you to record your vision for the future," she said.
She encouraged the nurses to believe in their potential and in their future. "What are your one-, three-, and five-year plans? What resources do you need to position yourself for success? Create and live your dreams as only an oncology nurse leader can. Nurses leading in oncology are transforming care across the globe."
This Oncology Times regular insert series is edited by OT Assistant Editor Sarah DiGiulio
Lead by Learning[horizontal ellipsis]
A key takeaway from several speakers this year at the meeting was that oncology nurses need to educate themselves and each other to stay up to date on the most important issues in the field in order to educate patients. Here are some resources shared at various sessions:
* On a patient's right to medical records (from the U.S. Department of Health & Human Services): http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html
* Health IT videos for patient education (fromhttp://HealthIT.gov): http://www.healthit.gov/patients-families/video/preview-health-it-you-giving-you
* On the Affordable Care Act and health care reform (from the Kaiser Family Foundation): http://www.kff.org
* On drug shortages (from the FDA): http://www.fda.gov/Drugs/DrugSafety/DrugShortages
* On the Food and Drug Administration Safety and Innovation Act (signed into law July 9, 2012) (FDASIA factsheet): http://1.usa.gov/13Eg2RF
* More on drug shortages (from the American Society of Healthcare Pharmacists): http://www.ashp.org/shortage