Maintaining Work/Life Balance and Passion for Your Work

Patti Palmer RN MS AOCNS

Charter Member of the Greater Sacramento

Chapter of the Oncology Nursing Society

30th Anniversary of GSCONS:

30 Years of Oncology Nursing

30-40 years ago:All of our oncology education came from the

Bay AreaVery little exposure to oncology nurses in our

trainingBarbara Piper , RN, MS, OCNS contacted

several of us and asked if we would like to meet and discuss forming an oncology nursing group

Over fondue in old Sacramento, the Sacramento Oncology Nursing Group (SONG) was born.

Sacramento Oncology Nursing Group

Patti Palmer: Oncology Nurse

That I would be coming home and having dreams about my patients

That I would feel sad and depressed for the first time in my life

That I would have trouble staying away from work on my days off and would fight the urge to call and check up

That I would be sitting in the family section with the families at the funerals

Was I crazy??? Or just human????

No One Told Me

If I were an oncology nurse I would be so depressed

I would be crying all the timeI would get involved with the patients and

their familiesYou must be an angel!!The BIG secret!!

You Must Be So Special!

Perry 2008 Creating moments of connectionMaking moments matterEnergizing Moments

(Cancer Oncology Nursing Journal, Spring 2008)

Lived Experiences of Exemplary Oncology Nurses

Creating Moments of Connection

Making Moments Matter

Energizing Moments

2 out 3 people live at least 5 years after cancer diagnosis (1 of 2 in 1970’s)

Cancer death rate has dropped 18% since the early 90’s

Progress reflects advances in every area of cancer care: prevention, screening, chemotherapy, surgery, radiation and molecularly targeted agents

And supportive care advances in the management of nausea, pain and other side effects

Quality of life is as important now as cancer free survival.

30 Years of Oncology Achievements

1986 PSA enables early detection prostate cancer, Tamoxifen reduces breast cancer

recurrence, global pain management guidelines

1989 Neupogen and Procrit1990’s Laparoscopic surgery, 3-D radiation

plans1991 Zofran 70-90’s Sun exposure and melanoma, smoking

and cancer

Cancer Milestones

1992-94 Taxanes as a vital option for breast and ovarian cancer

1997 Rituximab1998,2006 Herceptin2001 Imatinib (Gleevec) for CML then

GIST2003 Scientists decode the human

genome2003,2004 EGFR targeted drugs for lung

cancer, Bevacizumab

Cancer Milestones

2005 US launches efforts to map cancer genomes2005 research sheds light on long-term problems

of cancer survivors2004,2008 cetuximab (Erbitux) and panitumumab

(Vectibix) for colon cancer2006 HPV vaccine prevents cervical cancer2010 CT scanning reduces lung cancer deaths in

heavy smokers2010 ipilimumab (Yervoy) for melanoma2010 Adding palliative care to standard

treatment improves survival for advanced lung cancer

Cancer Milestones

22 year old male with Ewings Sarcoma spending days and weeks in the hospital.

Very little verbal interaction with staffI would spend time in his room at night

hoping that he would talk to meOne rainy nightHelped his parents cope with his dying7am or 7pmWhat is my grief and what is their grief??

Wayne:My First Lesson in Oncology Nursing

As much as you want to be the one and only for the patient, it is important to have the team support you in the care.

Teaching the team how to care for the patient improves everyone’s satisfaction

Multi-disciplinary huddles

Oncology Nursing Must be Done as a Team

Pavlish et al 2012 Nurse’s Responses to Ethical Challenges in Oncology Practice; Clinical Journal of Oncology Nursing

Looked at 30 oncology nurses and 12 key informants perspectives on ethically difficult situations

Nurses described their goals as: Being the eyes and arms of patient sufferingExperiencing the precariousness of competing

obligationsNavigating the intricacies of hope and honestyManaging the urgency caused by waitingStraining to find the timeWeighing risks of speaking out

Ethical Challenges in Oncology Practice

Implications for practiceDeveloping a nurse’s skill set (self assessment,

education)Systems that encourage and support open

ethics dialogue among healthcare team members

All voices matter and are heardManagers can create unit-based, ethics-trained

champions who work with staff

Ethical Challenges

Speakers encouraged me to get a massage, pedicure, a vacation

I had children and went back to school!!AND changed job settings until I found my

oncology “home” Burn Out now defined as arising from

cumulative, prolonged increase in stressSymptoms include withdrawal from emotional

scenarios at work, anger and decreased empathy

Some worked through it and some left oncology.

In the 80’s We Called it Burn Out

Coined in the 1990 by JoinsonDeep physical, emotional and spiritual consumption

accompanied by significant emotional pain (Pfifferling& Gilley, 2000)

A severe malaise as a result of caring for patients who are in pain and suffering (Sabo 2006)

Pessimism and cynicism evolve from self-perceptions of personal inadequacy in optimally managing patients’ illness trajectories.

Contradictory feelings of immense caring for patients in tandem with negative attitudes toward self can result in emotional overextension.

In 2014 We Call it Compassion Fatigue

An accumulation of unresolved grief Symptoms can mimic burnout

Emotional exhaustionFeeling of Inadequacy or failure

Will become chronic unless remedied through grief resolution

Chronic Compounded Grief

Loer and Schwartz (2001) “The Making of a Corporate Athlete” in Harvard Business Review

Trained corporate leaders in four capacities: physical, mental, emotional and spiritual.

These four states form the performance pyramid

Athletes are able to maintain the “Ideal Performance State” with capacity for endurance, strength, flexibility, self control and focus using two components of effect energy management

What Do You Have in Your Life to Balance the Work that You Do?

Rhythmic movement between energy expenditure (stress) and energy renewal (recovery) called oscillationStress stimulates growthRecovery stimulates energy

Rituals that promote this oscillation between stress and recovery

Effective Energy Management

Immerse yourselves in the science of oncology

Ask why like a 2 year oldFind a mentor who will teach you what you

don’t understandTeach someone else what you learnedWhen a patient asks a question you don’t

know the answer too… go find out what the answer is and teach them and yourself at the same time.

Lifelong Learning and Oncology

Teach About Compassion Fatigue When They Are Young

Create a Space for Quiet Meditation

Encourage Rituals to Release Fatigue

Create a Positive Work Environment

Grief and end of life training and education

Debrief with colleagues

Altering Patient Care Assignments

Retreats

Compassion Fatigue Training for Nurses

Practice responsible selfishness

Strategies of Stress Survival

Develop a Positive Support Group

Remember to Laugh

Seperate Work from Home

Redefine Success

18 year old male with lymphoblastic lymphoma

Started chemotherapyAround cycle 3 admitted to ICU with 4 organ

failureSurvived and was cured of his cancerHe came to work at our hospital because he

was so grateful that we had saved his life.My heart skips a beat every time I run into

him

Gus

Somehow They Grew Up to be Great Adults!!

Remember to PLAY

And PLAY

And Eat Ice Cream