Nurses could be their "own worst enemies." Resilient, adaptable, going the extra mile to fill gaps in the system and take on other roles when we see the need-although these qualities are commendable, if they start to become expected norms within a system or in an organization, then the consequences can be profoundly damaging. Compensating for system defects means that invariably our own jobs risk being compromised, and our priorities are at the mercy of other agendas that may or may not help us do the jobs we want or need to do. In the context of nursing workforce shortage and the ever-increasing demand of care due to the rising incidence of people diagnosed with cancer and prevalence of people living with cancer, protecting and strengthening nursing going into the future are of critical importance. As the first step, in this editorial, we call for actions from all cancer nurses to recommit ourselves to person-centered fundamental care (PCFC)-the core contribution we make to health, recovery, and care.1,2

Every nurse should know how to assess the needs for and deliver PCFC. Building on over a decade's empirical work, Kitson and colleagues,3 along with International Learning Collaborative members globally,2,4 have been painstakingly describing what fundamental care is and why we need to be more explicit in embedding it into our health and care systems.5 Failures in fundamental care delivery are widely documented,2 yet there is (to date) less agreement and alignment from the nursing profession on how to turn these challenges into growth and opportunities. Effective PCFC delivery requires cancer nurses to be able to think in an integrated way about a person's fundamental care needs.6 These include establishing a trusting relationship; integrating the physical, psychosocial, and relational needs of the patient; and being sensitive to the context or setting where the care is being experienced. The encounter between the nurse and the patient is dynamic, iterative, and negotiated in real time.

Challenges to having PCFC embedded as part of our day-to-day practice include the following: currently, fundamental care is so embedded in our undergraduate curricula that it becomes invisible7; delivering PCFC is perceived as "common sense" or a simple task and therefore not valued or reinforced in the nursing curriculum; new graduates talk about the lack of appreciation of fundamental care skills in the practice area,8 while paradoxically research on "missed care" and burnout in the nursing workforce identifies nurses' inability to provide PCFC as examples of the key elements leading to leaving the profession.9,10 Although people with cancer articulate the need for all aspects of fundamental care, they do not necessarily expect their nurses to be able to address all needs because of their "lack of time."11 Such findings highlight the need for the profession to examine and reexamine the following: (1) How do we ensure PCFC is not undermined in the nursing care? (2) What are the macrolevel, mesolevel, and microlevel barriers to PCFC, and how do we begin to overcome them? (3) How should PCFC manifest in day-to-day practice across all nursing and specialist nursing roles and all cancer care settings? (4) How do nurses partner with the "care networks" of people with cancer to ensure sustainable care delivery? These ongoing gaps in our conceptualization through debates and consensus of what constitutes cancer nurses' responsibility to assess the needs for and deliver PCFC should be addressed if we're going to future-proof cancer nursing moving forward.

Seizing the Future

The challenge and opportunity for nursing will be about how we can provide PCFC to all people with cancer, across all settings and the cancer care continuum. We call for actions from cancer nurse leaders to influence, lobby, and advocate for a more integrated approach to valuing PCFC assessment and delivery as a universal skill in nursing practice, which is protected and supported by skill mix, ratio, and resource policies. More research is required to explore how the myriad of nursing and specialist nursing roles exemplifies the core contribution of nursing to fulfill the fundamental needs of people with cancer. Our job in the future is not to take over care; but to hang on to our core contribution we make to health, recovery, and care.

Raymond Javan Chan, PhD, MAppSc (Research), BN, RN, FACN

Alison Kitson, DPhil, BSc(Hons), RN, FRCN, FAAN, FAHMS

Caring Futures Institute, College of Nursing and Health Sciences, Flinders University

References