Reflections from an Oncology Nurse on Oncology Nursing Day
This will be my last year to celebrate Oncology Nursing Day as a practicing oncology nurse. I plan to retire later this year and reaching such a significant milestone has prompted me to look back on my career. It has been 44 years since I entered the School of Nursing at the Royal Victoria Hospital in Belfast; 34 years since I was hired as a surgical nurse at Centenary hospital; and 26 years since I transferred to the Chemotherapy Clinic. Reflecting on my nursing life I can relate to a quote by a French writer named Colette when she said “What a wonderful life I’ve had! I only wish I’d realized it sooner”. For me, it’s “What a wonderful career I’ve had! I just haven’t always recognised it, while living it.”
Over my working life, nursing as a profession, has changed dramatically – as there was no degree program I was “trained”, I wore a dress, a white starched collar, apron, belt and fall and a cape; I was reprimanded when a Ward Sister overheard a patient call me by my first name rather than “Nurse Bell”; there was very little technology – we counted the number of drops per minute to regulate the rate of the intravenous infusion and the solutions were all in glass bottles; visiting hours were 30 minutes twice each day and were strictly observed; and length of hospital stays were significantly longer – to name but a few.
Yet, the core of nursing remains unchanged – there is a patient, often at a vulnerable time in their life in need of our care and expertise. We establish a personal rapport, help alleviate their pain and suffering, facilitate healing, prevent new injuries and illnesses from occurring, learn what their care goals are and advocate for them in order to enhance their living or dying.
When I tell people, I work in oncology the response is often “How can you? It must be so depressing” – but I don’t find that to be the case. In any area of nursing we see happiness and occasions to celebrate but we also witness sadness and loss. As a midwife I have known the wonder of delivering a baby and handing the infant over to the elated parents but I have also supported a mother as she made the difficult decision to put her baby up for adoption. In oncology we can celebrate the completion of treatment but often have to assist our patients to come to terms with disease progression. We all work in the real world.
Oncology, as a speciality, has advanced enormously over the past 30 years on a number of fronts. On a night shift in the mid 80’s I cared for a young man being treated for testicular cancer, who was experiencing intractable nausea and vomiting. I gave all the scheduled anti-nausea medication ordered knowing that they would do very little, if anything, to ease his symptoms. All I could do was to be with him as much as possible during that shift.
A class of medications known as 5-HT3 receptor antagonists, effective in preventing nausea and vomiting associated with cancer chemotherapy, including highly emetogenic chemotherapy only became available in 1990. Prior to this, K basins were widely used in chemo treatments rooms and now, we rarely see one. The increased access to central vascular devices has reduced sclerosis and tracking of veins and allows patients to receive continuous infusions of chemotherapy at home. There has been an influx of new drugs particularly in the last 15 -20 years that have changed the way we deliver care including targeted therapies, immunotherapies and oral chemotherapy treatments which are more effective in treating cancer. This in turn means that there are significantly more lines of treatment available to patients. It was only in 1997 that Cancer Care Ontario, which is responsible for improving cancer services in the province, was formally launched. Most recently, as a result of the pandemic, our follow up appointments are being conducted virtually as are our teaching sessions for those starting treatment.
Oncology nursing as a speciality has also developed over the years. The Oncology Nursing Certification was added to the Canadian Nurses Association’s nursing practice specialties in 1998. In 2008 the de Souza Institute was founded to provide continuing education for health care professionals offering a wide range of cancer related nursing topics. Having the Provincial Standardized Chemotherapy and Biotherapy Course is now a requirement to work in an Oncology Clinic and this must be maintained annually.
As much as things have changed throughout my career, there is one thing that will never change. When you’re a nurse, you know that everyday you will touch a life or a life will touch yours. Several years ago, a patient, who was marking 20 years of being free of lung cancer, returned to the Chemotherapy Clinic. He greeted me with the following words, “I remember you and will always be grateful for the way you helped me during one of the most difficult periods in my life”. I remembered him and the encounter he was referring to. How fulfilling to have left such a lasting positive impression on another.
Helen Hamilton, Oncology Best Practice Leader, Cancer Care and Hematology Clinics