ONS Sails Forward with an Optimist at the Helm

Paula Trahan Rieger, RN, MSN, CAE, FAAN, is the CEO of the Oncology Nursing Society (ONS) and previously served as ONS president. Rieger is a certified advanced oncology nurse, and she has received numerous awards throughout a long and storied career. When you speak with Rieger, her dedication to improving life for patients with cancer is readily apparent, a commitment that has never wavered since she entered oncology nursing more than 30 years ago. That commitment extends to making things better for nurses all over the world who are involved in caring for patients with cancer and cancer survivors.

When ONS started 35 years ago, it was a small group of a few hundred dedicated oncology nurses, Rieger said. Today it is one of the largest oncology professional organizations in the country and one of the top five nursing specialty organizations, with approximately 35,000 members. “When you look back, it is amazing how far a group of dedicated professionals with a continuing desire to make the world and the profession and, ultimately, the care of patients better can go.” Rieger said 10 years ago, ONS was working to pass the 30,000-member mark, and the goal this year is whether the organization will be able to cross the 40,000 mark.

ONS is looking to spread its reach beyond the nation’s borders, with an exciting project that Rieger said was launched at an international nursing conference in Atlanta last spring. “We’re looking to work with nursing organizations that are young and developing in other countries and finding ways to help them build good strong nursing organizations that we could ultimately partner with some day,” Rieger said. This involves educating nurses in the international arena to empower them with the leadership skills needed to make changes where they live and work. This presents some challenges. “You have to be mindful that culture and nursing practices differ in many countries,” she noted. “But you learn as much as you give.” Rieger said the key is to impart the knowledge and the leadership skills so that the nurses in these other countries can determine how to apply this information to care in their area and to integrate it when appropriate. “For example, with pain control there are many countries where the laws around the use of opiates are not what they need to be to facilitate good care of patients with pain,” Rieger explained. “So you teach nurses advocacy skills in their country, and a dedicated nurse with a passion can make a difference and get the laws changed or try to work through the appropriate channels to make things better at the regulatory level, so they can get patients what they need.”

For Rieger, so much of oncology nursing is about satisfying patients’ needs, and this includes making sure they are cared for when being treated outside the realm of specialized care. “At ONS, we recognize that not all patients who have cancer will necessarily be cared for by a specialty nurse,” she said. “There are many points along the continuum at which patients with cancer may intersect with a medical professional that is not necessarily an oncology specialist.” Some of these areas are in screening, genetic risk assessment, prevention, emergency care, and survivorship. It is easy to imagine many scenarios where a lack of knowledge on issues related to oncology could negatively affect care for a patient with cancer. At a poster session at ONS, for example, several presentations addressed educating non-oncology nurses on febrile neutropenia, an adverse effect associated with some cancer therapies that might require emergency treatment.

Rieger believes as the number of cancer survivors increases and the country feels the ramifications of a shortage in the oncology workforce, one of the greatest challenges for ONS will be getting critical information on caring for people affected by cancer to everyone who needs it, inside and outside of oncology nursing. “While we encourage and would love for all nurses that are interested in oncology to join ONS, we also want to position the knowledge that we have for non-oncology nurses and others that are touching the lives of patients with cancer.”

Survivorship offers substantial opportunity for ONS to educate other nurses and to connect with fellow nursing organizations. Many survivors are receiving follow-up care at survivorship clinics or, more often, they go back to their primary care providers, Rieger said. “As we become more successful with treating cancer, many more people are living with and through and beyond their cancer. How do we attend to their needs?” asked Rieger. That is one of the questions ONS is working hard to resolve.

Rieger described the strategic plan that ONS has developed to carry the organization through 2012. This plan has three pillars, she explained: knowledge, advocacy, and partnership. “We are continually expanding and looking at those areas in cancer care that have changed and determining how to prepare our members for the future,” she said. In addition to getting knowledge out to generalist nurses, another area ONS plan to address further is the emerging role of nurse navigation in oncology. There is also a faculty shortage that ONS hopes to find ways to counter. “How do we get oncology knowledge to the nurses that are being educated now and joining the work force?” is a key question the group will try to resolve.

Advocacy is another focus for ONS—“Speaking out in the policy arena for factors that we consider important to quality cancer care,” explained Rieger. The recently signed tobacco legislation was a major piece of ONS’ policy agenda, and Rieger expressed her satisfaction that it had finally passed. Prevention is something else in which ONS has taken deep interest, which refers not only to preventing cancer but also to preventing negative treatment- or disease-related effects. “Nurses are very important when you start talking about quality and safety and prevention of negative events in care,” said Rieger.

For the third pillar—partnership—Rieger noted that going it alone is difficult in today’s world. ONS is looking at working with other organizations that offer opportunities to help ONS meet its goal of making a difference in care. “The international work we are doing is a good example in partnership,” Rieger said, “And determining how we can work with our physician colleagues.” The American Society of Clinical Oncology is doing a lot to examine the workforce in oncology, and a “huge piece of that” involves nurse practitioners, which constitute a dedicated segment of ONS members, according to Rieger. She believes the role of nurse practitioners will be evolving and their contributions to the healthcare system will continue to grow and strengthen.

The numbers of oncology nurses have held relatively steady, and Rieger said part of ONS’ efforts involve promoting nursing as a profession, in part through its work with the National Student Nurses Association. “And then, of course, to make sure people know what a wonderful career oncology nursing is,” she added.

Rieger acknowledged that the looming shortage of oncology professionals concerns her but she believes they will, nevertheless, find new and improved care models that allow them to get the work done while still providing the best care. “Even though we have a lot of challenges in the future of healthcare, I always in my heart believe that we’ll be able to come together and continue to provide the best for patients,” she said. Rieger pointed to all the wonderful advances in technology and the growing impact of social media as tools that will help ONS provide education to its members and to nurses who are not members but who play an important role in interacting with patients and families.

If you are a nurse interested in specializing in oncology or who wants to educate yourself on some of the concerns of caring for patients with cancer and cancer survivors, visit www.ons.org.