Career guidance
Career opportunities in oncology Louise Farrow, Guy’s Hospital, London
Oncology nursing is a specialist field that offers a wide range of opportunities for nurses. This article will highlight these opportunities, and discuss the advantages and disadvantages of selecting oncology as a possible career pathway.
M „„„„ ,
though cancer may be perceived as a ter minal illness it can now often be success fully treated, boasting an overall cure rate that is greater than many other chronic ill nesses. McCaffrey also predicts that cure rates will rise to 67% by the first decade of the 21st century. Attitudes towards can cer arc slowly changing and the importance of maintaining a satisfactory quality of life for patients with cancer is now recognized. The oncology nurse has to embrace a wide spectrum of nursing skills in order to care for individuals with acute oncological illnesses as well as those requiring palliative care. Specialized oncology units within teaching and district general hospitals are now established and these offer nurses the opportunity to care for patients with a wide range of oncological problems. The diver sity of cancers and their subsequent man agement necessitate these environments to be equipped with the relevant knowledge and facilities for training.
What can oncology nursing offer?
Ms I arrow is a Ward Sister on the Oncology Unit at Guy’s Hospital, London
tients with cerebral tumours present with neurological problems, and patients with gastrointestinal cancers present with acute surgical problems such as subacute obstruc tion. Treatments The treatment offered to patients depends upon the diagnosis. The available treat ments include radiotherapy, surgery, chemotherapy and bone marrow transplan tation. Clinical environments The cancer patient can be nursed in a var iety of settings ranging from acute medical and surgical wards to hospices. General on cology units offer the facilities to nurse both patients with acute oncological dis orders and those who arc terminally ill.
Oncology nursing as a career
There arc many reasons why nurses choose oncology as a career (Tabic 2).
Tabic 1 illustrates the different categories within the oncology specialty.
Table 1. Categories within the oncology specialty
Client group Cancer affects people of all ages and oncol ogy nursing therefore offers nurses the op portunity to care for patients over a wide range of ages. The establishment of paediat ric wards enables RSCNs to undertake the paediatric oncology course and The Middlesex Hospital in London has an ado lescent oncology unit. General oncology units admit patients aged 18 years and over and so the age range of patients is wide.
Paediatric nursing/elderly nursing_____
Diagnosis There arc a variety of diagnoses within on cology ranging from solid tumours to ma lignant haematojogical disorders. Cancer affects most of the body systems and each one must be treated accordingly. Nurses need to be aware of the problems that can be encountered with each tumour, e.g. pa
British Journal of Nursing, I i)92, Vol I, No 13
Solid tumours/haematological disorders Intensive, curative treatments/palliation and symptom control________________ Medical nursing/surgical nursing Acute units/hospice settings__________ Community/research________________
Table 2. Reasons why nurses choose oncology as a career Nurse/patient relationship Variety o f patient groups Variety o f treatments Multidisciplinary team Unpredictability
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Career opportunities in oncology ( Patients with cancer receive a diversity of treatments. Each requires different skills and therefore nurses must be able to develop and utilize a wide range of skills and increase their expertise as practitioners. 5
Nurse/patient relationship The nature of cancer and its treatments means that a unique nurse/patient relation ship builds up as the nurse becomes an inte gral part of the family unit’s way of life over a period of months, or even years. While this relationship can be intense, nurses generally find it enhances job satis faction. Variety of patient groups The variety of diagnoses, clientele and treatments offer a number of challenges. The nurse is faced with a diverse range of malignant disorders and therefore has to meet varying needs. Each patient must be considered as an individual. Variety of treatments The treatment chosen depends upon the classification and site of the cancer. Surgery can be used as a sole treatment or as adjuvant therapy, e.g. in cancer of the bowel or breast. Diagnosis is often first es tablished during surgery. Chemotherapy is the administration of cytotoxic drugs which literally means ‘cell poisoning’. It is used both as an intensive, curative treatment and in the management of symptom control. It can also be used in conjunction with surgery and radiothera py. Nurses working within an oncological environment need to be aware of the poten tial hazards of cytotoxic therapies. It is a complicated subject that requires knowl edge from specialized personnel and many oncology centres now employ specialist nurses who work solely within the field of chemotherapy. Radiotherapy is the use of X-rays, as either external or internal beam therapies, e.g. cae sium implants or iridium needles. Radio therapy can be used effectively in the treat ment of localized disease as well as in sys tem control. Patients with cancer receive a diversity of treatments, each requiring different skills. Nurses are therefore able to develop and utilize a wide range of skills and in crease their expertise as practitioners. Multidisciplinary team The multidisciplinary team approach is es sential as the overall aim of treatment for the patient with cancer is to improve his/her quality of life. Rehabilitation is an important component of their care; Fulton (1990) defines it as ‘the restoration of pa tients to their fullest physical, mental and social capability’. Hospices offer
682
Table 3. Advantages and disadvantages of oncology nursing A d v a n ta g e s
Variety Multidisciplinary team approach Job satisfaction Unpredictability Stress Nurse/patient relationship
D is a d v a n ta g e s Stress Acting as patient’s advocate Unpredictability Time consuming Psychological pressure
rehablitation programmes and patients from acute oncology units can be referred to some of these programmes before dis charge. The philisophy of rehabilitation is a use ful one to adopt as it helps the patient and his/her family come to terms with the con cept of cancer as a chronic illness. Family members play a vital role in rehabilitation and their participation proves invaluable. Oncology units incorporate a strong multidisciplinary team approach and nurses work closely with physiotherapists, dietitians, occupational therapists and specialist nurses such as breast-care nurses and support/MacMillan nurses. All of these team members become accustomed to on cology patients’ individual and specialist needs. Unpredictability Working within oncology can be as unpre dictable as working within any clinical en vironment. Oncological emergencies such as septicaemia and spinal cord compression require prompt intervention by both the medical and nursing teams. This enhances teamwork and enables the nurse to utilize his/her communication and management skills in relation to the acutely ill patient.
Advantages and disadvantages
As in any environment, aspects that are considered advantages by some nurses may be seen as disadvantages by others (Table J). At times the pressures exerted on nurses
British Journalbyof129.215.017.190 Nursing, 1992, Vol I, No 1319, 2019. Downloaded from magonlinelibrary.com on January
Career opportunities in oncology working in oncology can be immense but everyone has different coping mechanisms which develop further as experience in creases. Time is always an issue in any nursing situation and oncological nursing can make enormous demands on nurses’ time. This is particularly true of psychological support which is an important but demanding as pect of care if patients’ quality of life is to be improved; however, some nurses find this aspect the most rewarding. Nursing is a stressful occupation and nursing patients with cancer is particularly stressful as nurses have to deal with situ ations that range from a patient being told that his/her cancer has spread, to looking after a patient over a period of time who then dies. Research conducted by Owen (1989) and Lansdown et al (1990) shows that staff support groups can prove invalu able in helping to combat stress. Oncology units are aware of the stress exerted on nurses and adopt different methods of help ing staff to cope with the pressures.
How to get into oncology?
Most nurses have the opportunity to care for cancer patients throughout their train ing and career as such patients are nursed not only in specialized units but also in the general ward environment. Nurses who choose to specialize in oncology have rec ognized a close affiliation with cancer pa tients during their training and want to broaden their knowledge bases. After qualifying, a staff nurse can apply for grade D posts within most specialized units. However, it is beneficial for the nurse to gain some general medical or surgical ex perience before specializing as this enables him/her to become a more confident practitioner and manager. The English National Board (ENB) runs KEY POINTS • Oncology nursing offers nurses a wide range of opportunities. • Nurses need a wide range of skills in order to care for patients who may have acute oncological illnesses or require palliative care. • The nature of the nurse/patlent relationship can be intense. Nurses generally find this enhances job satisfaction. • The pressures exerted on nurses working in oncology can be immense. • Oncology nursing is rewarding but very demanding and therefore the nurse has to be resourceful. • Early career planning is advisable to take advantage of the opportunities that are currently available.
British Journal of Nursing, 1992, Vol l,N ol3
Table 4. Possible career pathways in oncology nursing Acute hospital environments — medical o r surgery___________________ ______ Outpatients departm ent ____________ Bone m arrow transplantation units Hospices___________________________ Community, e.g. MacMillan nurse______ Counselling_________________________ Research___________________________ Clinical nurse specialists______________ Education
a number of postregistration courses de signed specifically for oncology nursing. These include the ENB237 Oncological Nursing Course for Registered Nurses and the ENB931 Care of the Dying Patient and his Family course. With the advent of the ENB changes and the Framework for Higher Education (ENB, 1991), these courses are being devel oped into diploma level qualifications. The Diploma in Oncology Nursing is currently in progress at The Royal Marsden Hospital, London. There are also accredited courses available which are run in conjunction with the University of Manchester in the subspecialties of oncology, e.g. bone mar row transplantation and care of the patient with breast cancer. Training centres usually expect nurses to have at least 9 months postregistration ex perience before undertaking a course. The waiting lists are long as there are a limited number of approved centres that offer the courses and this must be taken into con sideration when applying. Once the nurse has embarked on a career in oncology nurs ing, there are a number of pathways that can be considered (Table 4). In the current job market, it is advisable to have good career planning; with the wide range of opportunities available in oncol ogy, nurses must gain the required knowl edge, skills, experience and qualifications for the pathway they want to take. ENB (1991) Framework for the Higher Award for Continuing Professional Education for Nurses, Midwifes and Ftealth Visitors. ENB, London Fulton C (1990) Rehabilitation and the cancer patient. Nurs Times 86(34):39-4l Lansdown R, Pike S, Smith M (1990) Reducing stress in the cancer ward. Nurs Times 86(38):34-7 McCaffrey 13 (1991) Surviving cancer. Nurs Times 87(32):26-30 Owen S (1989) Strategies for stress. Nurs Times 83(37):38-9
683
Downloaded from magonlinelibrary.com by 129.215.017.190 on January 19, 2019.
Career opportunities in oncology Louise Farrow, Guy’s Hospital, London
Oncology nursing is a specialist field that offers a wide range of opportunities for nurses. This article will highlight these opportunities, and discuss the advantages and disadvantages of selecting oncology as a possible career pathway.
M „„„„ ,
though cancer may be perceived as a ter minal illness it can now often be success fully treated, boasting an overall cure rate that is greater than many other chronic ill nesses. McCaffrey also predicts that cure rates will rise to 67% by the first decade of the 21st century. Attitudes towards can cer arc slowly changing and the importance of maintaining a satisfactory quality of life for patients with cancer is now recognized. The oncology nurse has to embrace a wide spectrum of nursing skills in order to care for individuals with acute oncological illnesses as well as those requiring palliative care. Specialized oncology units within teaching and district general hospitals are now established and these offer nurses the opportunity to care for patients with a wide range of oncological problems. The diver sity of cancers and their subsequent man agement necessitate these environments to be equipped with the relevant knowledge and facilities for training.
What can oncology nursing offer?
Ms I arrow is a Ward Sister on the Oncology Unit at Guy’s Hospital, London
tients with cerebral tumours present with neurological problems, and patients with gastrointestinal cancers present with acute surgical problems such as subacute obstruc tion. Treatments The treatment offered to patients depends upon the diagnosis. The available treat ments include radiotherapy, surgery, chemotherapy and bone marrow transplan tation. Clinical environments The cancer patient can be nursed in a var iety of settings ranging from acute medical and surgical wards to hospices. General on cology units offer the facilities to nurse both patients with acute oncological dis orders and those who arc terminally ill.
Oncology nursing as a career
There arc many reasons why nurses choose oncology as a career (Tabic 2).
Tabic 1 illustrates the different categories within the oncology specialty.
Table 1. Categories within the oncology specialty
Client group Cancer affects people of all ages and oncol ogy nursing therefore offers nurses the op portunity to care for patients over a wide range of ages. The establishment of paediat ric wards enables RSCNs to undertake the paediatric oncology course and The Middlesex Hospital in London has an ado lescent oncology unit. General oncology units admit patients aged 18 years and over and so the age range of patients is wide.
Paediatric nursing/elderly nursing_____
Diagnosis There arc a variety of diagnoses within on cology ranging from solid tumours to ma lignant haematojogical disorders. Cancer affects most of the body systems and each one must be treated accordingly. Nurses need to be aware of the problems that can be encountered with each tumour, e.g. pa
British Journal of Nursing, I i)92, Vol I, No 13
Solid tumours/haematological disorders Intensive, curative treatments/palliation and symptom control________________ Medical nursing/surgical nursing Acute units/hospice settings__________ Community/research________________
Table 2. Reasons why nurses choose oncology as a career Nurse/patient relationship Variety o f patient groups Variety o f treatments Multidisciplinary team Unpredictability
681
Downloaded from magonlinelibrary.com by 129.215.017.190 on January 19, 2019.
Career opportunities in oncology ( Patients with cancer receive a diversity of treatments. Each requires different skills and therefore nurses must be able to develop and utilize a wide range of skills and increase their expertise as practitioners. 5
Nurse/patient relationship The nature of cancer and its treatments means that a unique nurse/patient relation ship builds up as the nurse becomes an inte gral part of the family unit’s way of life over a period of months, or even years. While this relationship can be intense, nurses generally find it enhances job satis faction. Variety of patient groups The variety of diagnoses, clientele and treatments offer a number of challenges. The nurse is faced with a diverse range of malignant disorders and therefore has to meet varying needs. Each patient must be considered as an individual. Variety of treatments The treatment chosen depends upon the classification and site of the cancer. Surgery can be used as a sole treatment or as adjuvant therapy, e.g. in cancer of the bowel or breast. Diagnosis is often first es tablished during surgery. Chemotherapy is the administration of cytotoxic drugs which literally means ‘cell poisoning’. It is used both as an intensive, curative treatment and in the management of symptom control. It can also be used in conjunction with surgery and radiothera py. Nurses working within an oncological environment need to be aware of the poten tial hazards of cytotoxic therapies. It is a complicated subject that requires knowl edge from specialized personnel and many oncology centres now employ specialist nurses who work solely within the field of chemotherapy. Radiotherapy is the use of X-rays, as either external or internal beam therapies, e.g. cae sium implants or iridium needles. Radio therapy can be used effectively in the treat ment of localized disease as well as in sys tem control. Patients with cancer receive a diversity of treatments, each requiring different skills. Nurses are therefore able to develop and utilize a wide range of skills and in crease their expertise as practitioners. Multidisciplinary team The multidisciplinary team approach is es sential as the overall aim of treatment for the patient with cancer is to improve his/her quality of life. Rehabilitation is an important component of their care; Fulton (1990) defines it as ‘the restoration of pa tients to their fullest physical, mental and social capability’. Hospices offer
682
Table 3. Advantages and disadvantages of oncology nursing A d v a n ta g e s
Variety Multidisciplinary team approach Job satisfaction Unpredictability Stress Nurse/patient relationship
D is a d v a n ta g e s Stress Acting as patient’s advocate Unpredictability Time consuming Psychological pressure
rehablitation programmes and patients from acute oncology units can be referred to some of these programmes before dis charge. The philisophy of rehabilitation is a use ful one to adopt as it helps the patient and his/her family come to terms with the con cept of cancer as a chronic illness. Family members play a vital role in rehabilitation and their participation proves invaluable. Oncology units incorporate a strong multidisciplinary team approach and nurses work closely with physiotherapists, dietitians, occupational therapists and specialist nurses such as breast-care nurses and support/MacMillan nurses. All of these team members become accustomed to on cology patients’ individual and specialist needs. Unpredictability Working within oncology can be as unpre dictable as working within any clinical en vironment. Oncological emergencies such as septicaemia and spinal cord compression require prompt intervention by both the medical and nursing teams. This enhances teamwork and enables the nurse to utilize his/her communication and management skills in relation to the acutely ill patient.
Advantages and disadvantages
As in any environment, aspects that are considered advantages by some nurses may be seen as disadvantages by others (Table J). At times the pressures exerted on nurses
British Journalbyof129.215.017.190 Nursing, 1992, Vol I, No 1319, 2019. Downloaded from magonlinelibrary.com on January
Career opportunities in oncology working in oncology can be immense but everyone has different coping mechanisms which develop further as experience in creases. Time is always an issue in any nursing situation and oncological nursing can make enormous demands on nurses’ time. This is particularly true of psychological support which is an important but demanding as pect of care if patients’ quality of life is to be improved; however, some nurses find this aspect the most rewarding. Nursing is a stressful occupation and nursing patients with cancer is particularly stressful as nurses have to deal with situ ations that range from a patient being told that his/her cancer has spread, to looking after a patient over a period of time who then dies. Research conducted by Owen (1989) and Lansdown et al (1990) shows that staff support groups can prove invalu able in helping to combat stress. Oncology units are aware of the stress exerted on nurses and adopt different methods of help ing staff to cope with the pressures.
How to get into oncology?
Most nurses have the opportunity to care for cancer patients throughout their train ing and career as such patients are nursed not only in specialized units but also in the general ward environment. Nurses who choose to specialize in oncology have rec ognized a close affiliation with cancer pa tients during their training and want to broaden their knowledge bases. After qualifying, a staff nurse can apply for grade D posts within most specialized units. However, it is beneficial for the nurse to gain some general medical or surgical ex perience before specializing as this enables him/her to become a more confident practitioner and manager. The English National Board (ENB) runs KEY POINTS • Oncology nursing offers nurses a wide range of opportunities. • Nurses need a wide range of skills in order to care for patients who may have acute oncological illnesses or require palliative care. • The nature of the nurse/patlent relationship can be intense. Nurses generally find this enhances job satisfaction. • The pressures exerted on nurses working in oncology can be immense. • Oncology nursing is rewarding but very demanding and therefore the nurse has to be resourceful. • Early career planning is advisable to take advantage of the opportunities that are currently available.
British Journal of Nursing, 1992, Vol l,N ol3
Table 4. Possible career pathways in oncology nursing Acute hospital environments — medical o r surgery___________________ ______ Outpatients departm ent ____________ Bone m arrow transplantation units Hospices___________________________ Community, e.g. MacMillan nurse______ Counselling_________________________ Research___________________________ Clinical nurse specialists______________ Education
a number of postregistration courses de signed specifically for oncology nursing. These include the ENB237 Oncological Nursing Course for Registered Nurses and the ENB931 Care of the Dying Patient and his Family course. With the advent of the ENB changes and the Framework for Higher Education (ENB, 1991), these courses are being devel oped into diploma level qualifications. The Diploma in Oncology Nursing is currently in progress at The Royal Marsden Hospital, London. There are also accredited courses available which are run in conjunction with the University of Manchester in the subspecialties of oncology, e.g. bone mar row transplantation and care of the patient with breast cancer. Training centres usually expect nurses to have at least 9 months postregistration ex perience before undertaking a course. The waiting lists are long as there are a limited number of approved centres that offer the courses and this must be taken into con sideration when applying. Once the nurse has embarked on a career in oncology nurs ing, there are a number of pathways that can be considered (Table 4). In the current job market, it is advisable to have good career planning; with the wide range of opportunities available in oncol ogy, nurses must gain the required knowl edge, skills, experience and qualifications for the pathway they want to take. ENB (1991) Framework for the Higher Award for Continuing Professional Education for Nurses, Midwifes and Ftealth Visitors. ENB, London Fulton C (1990) Rehabilitation and the cancer patient. Nurs Times 86(34):39-4l Lansdown R, Pike S, Smith M (1990) Reducing stress in the cancer ward. Nurs Times 86(38):34-7 McCaffrey 13 (1991) Surviving cancer. Nurs Times 87(32):26-30 Owen S (1989) Strategies for stress. Nurs Times 83(37):38-9
683
Downloaded from magonlinelibrary.com by 129.215.017.190 on January 19, 2019.
