Building a Renowned Clinical Nurse Specialist Team: Recruitment, Role Development, and Value Identification.

PURPOSE: This article will describe the outcomes associated with restructuring clinical nurse specialists (CNSs) into a centralized model with dedicated efforts focused on team and individual development. METHODS: A multiphase journey was undertaken to rebuild a team of CNSs after years of open vacancies and role confusion. After restructuring to a centralized model, a multiphase approach was taken that included innovative recruitment strategies, development of a talent pipeline through enhancement of student clinical placements, team and individual development activities, and value identification. Description of methods used for individual and team development is discussed in depth within this article, including achieving role standardization and optimization. OUTCOMES: Numerous outcomes were associated with this effort and are described within this article. Among them were the hiring of 21 CNSs, increased representation on hospital-wide committees and councils, quantification of the work contribution of CNSs within the organization, and a $1 568 229.36 cost avoidance associated with CNS work efforts, all in the first 24 months. CONCLUSION: As challenges facing the role put it at risk and healthcare becomes increasingly value based, the need for expert clinicians who can demonstrate their value becomes essential. Clinical nurse specialists and hospital leadership can benefit from exploring successful interventions to rebuild CNS teams to achieve these goals.

Keep Caregivers Safe: Reduce Secondary Exposure to Chemotherapy.

Chemotherapy exposure during drug administration and provision of care is a known risk for oncology nurses and other healthcare workers. Guidelines to minimize exposure to hazardous drugs, such as chemotherapy, have long been in place to decrease potential health risks.

The Challenge of Rare Cancers in Current and Advancing Treatment.

The term rare cancers is relatively new in oncology, with significant presence in cancer literature occurring only since the early 2000s. Epidemiologic studies in Europe and the United States show that rare cancers account for about 25% of adult cancers (Eslick, 2012). However, rare cancer types have been traditionally understudied, with an associated lack of progress in survival and challenges in decision making for patients, physicians, and policy makers (Greenlee et al., 2010). Initiatives led within the European Union and with the United States are intended to boost progress in treatment for rare cancers through collective research and shared databases (Keat et al., 2013). Nurses see patients with rare cancers struggle for access to quality, evidence-based care, as well as the isolation they endure as they seek the information and support needed to cope with the diagnosis of a life-threatening illness..

A Review of "Challenging Situations When Administering Palliative Chemotherapy--A Nursing Perspective".

The December 2014 issue of the European Journal of Oncology Nursing published an article by Näppä, Rasmussen, Axelsson, and Lindqvist that reported on a qualitative study of the challenges experienced by Swedish nurses when administering palliative cancer treatment at the end of life. The study identified the various clinical scenarios that create dilemmas among nurses. The authors described why chemotherapy at the end of life has become so prevalent and offered strategies to minimize or prevent the moral distress that can occur. Research from the United States identified similar trends in end-of-life treatment and supportive recommendations for multidisciplinary palliative care team collaboration as a solution.

Transitioning to cancer survivorship: plans of care.

Survivorship care plans have received increasing attention since the 2006 release of the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. The report strongly recommends that at completion of cancer treatment, clinicians provide patients with a summary of treatment delivered and a detailed plan of ongoing care, including follow-up schedules for visits and testing, as well as recommendations for early detection and management of treatment-related effects and other health problems. Templates have been developed by various groups to support the effort involved in complying with this recommendation. Barriers exist, such as difficulties in accessing information, preparation time involved for busy clinicians, lack of third-party reimbursement, and absence of clear guidelines for follow-up care after cancer treatment. The absence of research related to care plans and patient outcomes also calls their necessity into question. Yet, there is a growing acceptance among oncology physicians and nurses that having a plan of care is an essential component of quality survivorship care.