I Editorial

134 Volume 25, Issue 2, sprIng 2015 • CanadIan onCology nursIng Journal
reVue CanadIenne de soIns InfIrmIers en onCologIe
Editorial
In 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 dierence 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 signicant 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 sta and the
environment to deliver care. Often the implementation of a model of care involves dierent 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, embrac-
ing 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 identied
patient need).
These are complex topics and have important implications for oncology nurses and oncol-
ogy 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 inuences 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 dierent 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 inuence the results of these discussions, we need to under-
stand 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 sta 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 eective and meaningful delivery of care if we are patient or
person centred in our approaches.

135
Canadian OnCOlOgy nursing JOurnal • VOlume 25, issue 2, spring 2015
reVue Canadienne de sOins infirmiers en OnCOlOgie
The article from Janzen and Perry describes actions by oncology nurses in patient care situa-
tions where there is a sense of hopelessness and futility. The actions these nurses took, to ensure
patient needs were met in these situations, reect 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 pur-
suit of continuing education and skill and in their eorts to provide quality care in this complex
health care environment today. Intentional planning for education and advocacy in the work-
place 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 can-
cer 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, oering edu-
cational opportunities, connecting nurses through networks and communities of practice) pro-
vides guidance for nurses in their work settings. It contributes to their capacity to speak about
nursing roles, nursing’s inuence 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
eld. 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