Editorial I n the course of my work, I have the opportunity to speak with oncology nurses across Canada on a regular basis. I love to hear what oncology nurses are doing and their stories about their practice. I am constantly moved by their descriptions about how they make a difference in the lives of patients and families. And I am intrigued to hear how they are facing the challenges in their work settings and ensuring patients are getting the kind of help and care they need. During these conversations, three topics have emerged recently as significant challenges for oncology nurses. These topics are models of care, scope of practice, and inter-professional teamwork. ‘Models of care’ is a phase that refers to the way agencies are organizing their staff and the environment to deliver care. Often the implementation of a model of care involves different ways of working, and new roles and responsibilities. The notion of ‘scope of practice’ is often cited to illustrate whether or not nurses are working to the full range of their knowledge and education. Far too often I hear a call for nurses to be able to work to their full scope, as their current roles are seen as too narrow, focused to a great extent on tasks alone and, in many cases, embracing many non-nursing responsibilities. The dialogue about inter-professional team practice is seen as a vehicle to determine how to provide the right care (evidence based and in accordance with the individual’s needs) to patients at the right time (without undue waits) by the appropriate health care provider (the team member who has the knowledge and skill to address the identified patient need). These are complex topics and have important implications for oncology nurses and oncology nursing practice. They also have important implications for patients and patient care. As a professional group, oncology nurses ought to be talking about the issues together. We need to understand the underlying influences driving these changes in health care, consider the impact of the various approaches, and anticipate the outcomes for patients and families of moving in certain directions. I am certain that different models of care, scopes of practice, and roles of the inter-professional team members will have an impact on patients’ care and the end results for them. To engage in discussions and to influence the results of these discussions, we need to understand patient needs, the best ways to meet those needs, and the types of contributions we can make as nurses and as members of inter-professional teams. We need to be able to describe and talk about each of these aspects clearly and know what is best for patient care. I am hoping the articles and features in this issue of CONJ will assist in the dialogue about these issues. The articles by Wilkins and by Loughery and Woodgate contribute to understanding the needs of two rather unique patient populations. Wilkins describes perspectives of individuals who have experienced more than one primary cancer diagnosis while Loughery and Woodgate focus on the supportive care needs of women with breast cancer living in rural settings. Nurses are in wonderful positions, whether in front-line staff roles, educators or researchers, to add to the evidence about patient needs by capturing the perspectives of those individuals and helping to communicate the ideas as seen through the eyes of the individuals. We will be able to advocate with a strong voice and organize effective and meaningful delivery of care if we are patient or person centred in our approaches. 134 Volume 25, Issue 2, spring 2015 • Canadian Oncology Nursing Journal Revue canadienne de soins infirmiers en oncologie The article from Janzen and Perry describes actions by oncology nurses in patient care situations where there is a sense of hopelessness and futility. The actions these nurses took, to ensure patient needs were met in these situations, reflect what can happen when nurses work to the full scope of practice for which they have been educated. The article by Savage and colleagues, and the features from O’Leary and from Severson, emphasize the need for astute leadership and multiple strategies to support nurses in their pursuit of continuing education and skill and in their efforts to provide quality care in this complex health care environment today. Intentional planning for education and advocacy in the workplace is required to ensure that oncology nurses have access to the necessary knowledge and skill to work to their full scope of practice. When nurses are working to their full scope, the outcomes for patients and families are enhanced. It is critically important that professional organizations are able to describe standards of cancer nursing practice and articulate the required knowledge and skill to enact those standards. Innovative continuing education and professional development strategies are needed to enable nurses to maintain these standards and expand their practice competencies. Leadership by professional nursing organizations such as CANO/ACIO (i.e., setting standards, offering educational opportunities, connecting nurses through networks and communities of practice) provides guidance for nurses in their work settings. It contributes to their capacity to speak about nursing roles, nursing’s influence on patient outcomes, and what constitutes best practice or care approaches. Cancer patients, survivors, and their families need powerful nurses. They need nurses who understand their unique perspectives as individuals living with cancer and their needs for care. They require nurses who are lifelong learners and keep up to date with the knowledge in their field. And they deserve nurses who are engaged in workplace redesign, developing models of care with the patient and family as a central consideration, and engaging in inter-professional practice. Patients need oncology nurses who are well prepared to speak out about the needs of persons living with cancer and how we can be both evidence-based and person-centred in our care approaches. Margaret Fitch, RN, PhD Editor in Chief Canadian Oncology Nursing Journal • Volume 25, Issue 2, spring 2015 Revue canadienne de soins infirmiers en oncologie 135