january 2010 ons connect
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The January edition of ONS Connect, the Oncology Nursing Society's official news magazineTRANSCRIPT
January 2010 ONS CONNECT 1
JANUARY 2010
connect
Turn to page 19 for oncology nursing job listings.
The official news magazine of The oncology nursing socieTy
Page 10
When Patients Can’t Afford to Have Cancer
Nursing Safety for Oral Hazardous DrugsPage 8
How Long Is Too Long to Hospitalize Patients?Page 17
Jean Sellers, RN, MSN, OCN®
Practice What You Know: Validating Your Reimbursement Competency
You’ve completed the ONS reimbursement course, right? Now, confirm your compe-tency in complicated oncology billing calculations and case scenarios by taking the test Practice What You Know: Validating Your Reimbursement Competency (www.ons.org/CourseDetail.aspx?course_id=30). This detailed test will confirm your reimbursement coding skills, offer additional practice, and help you gain confidence in this important skill.
The Web-based competency test covers all of the critical skills required in oncology practice to help you demonstrate your proficiency in reimbursement and coding. It also offers more patient billing scenarios and calculations to further enhance your skills!
At the completion of the test, you will be able to
Accurately identify chemotherapy versus therapeutic drugs•
Accurately calculate billing units typically utilized in oncology practice•
Accurately identify drug and administration codes.•
The Practice What You Know test is appropriate for anyone who has completed the Reimbursement for Nurses and Managers: The Keys to Successful Practice course (www.ons.org/CourseDetail.aspx?course_id=29), as well as for anyone who has expe-rience with coding and would benefit from more practice or the desire to demonstrate competency in this skill.
The competency test is modestly priced at $14.99 for ONS members. Or, check out the bundle (www.ons.org/CourseDetail.aspx?course_id=42) that includes both the course and the test for only $40. At these prices, you can’t afford not to participate. Just think, if you avoid just one billing error, that would more than pay the cost!Practice What You Know!
Take the test to confirm your skills.
www.ons.org/CNECentral
www.ons.org
4 ONS CONNECT January 2010 January 2010 ONS CONNECT 5
Should You Tell the Staff That Is Caring for Your Family Member That You’re a Nurse?
In response to November ONS Connect’s instant poll, “Should you tell the staff that is car-ing for your family member that you’re a nurse?” 64% indicated “yes” (N = 106).
To respond to this month’s poll, “Have you ever felt compelled to give money directly to a patient for medication, meals, gas, etc.?” visit www.ONSConnect.org. Results will be shared in an upcoming issue. ✱
ONS Connect is published monthly as a benefit for mem-bers of the Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275-1214 USA.
MissionThe mission of ONS Connect is to • Provide timely news and resources to oncology nurses
that can be incorporated easily into daily practice. • Communicate ONS updates and news.• Reinforce ONS as an industry leader and an authority in
the healthcare field.
Editor Debra M. Wujcik, RN, PhD, AOCN® E-mail: [email protected]
Contributing Editors Seth Eisenberg, RN, OCN® Marilyn L. Haas, PhD, RN, CNS, ANP-BCDeborah McBride, RN, MSN, CPON® Jennifer K. Mitchell, MSN, ANP-BC, GNP-BCHeather McCreery, RN, BS, OCN®, CCRCSusan Pillet, RN, CPNP, CPON®
Joseph D. Tariman, RN, MN, ARNP-BC, OCN® Erin Wyatt, MSN, RN, OCN®, CBCN
ONS Communications Staff Leonard Mafrica, MBA, CAE, Publisher Anne Snively, BS, CAE, Director of Communications Elisa Becze, BA, ELS, Managing Editor and Staff Writer Carrie Smith, BA, Copy Editor and Staff WriterJason Mosley, Graphic Designer
ONS President Brenda Nevidjon, RN, MSN, FAAN
ONS Chief Executive Officer Paula T. Rieger, RN, MSN, AOCN®, FAAN
National Office Information Phone: 866-257-4ONS, +1-412-859-6100 Fax: 877-369-5497, +1-412-859-6163 E-mail: [email protected] ONS Web site: www.ons.org
ONS supports the principle of financial disclosure and has taken steps to ensure that all ONS editors, editorial board members, reviewers, and authors understand and comply with its policy. ONS also respects the privacy of its custom-ers. Copies of the ONS Financial Disclosure Policy and ONS Privacy Policy are available upon request by contacting ONS at [email protected] or 125 Enterprise Drive, Pittsburgh, PA 15275-1214 USA, Attn: Customer Service.
All advertising is subject to the approval of the editor and publisher.
ONS Mission StatementThe mission of the Oncology Nursing Society is to promote excellence in oncology nursing and quality cancer care.
ONS Core Values Integrity • Innovation • Stewardship
Advocacy • Excellence • Inclusiveness
connectINSTANTPOLL
64% said yes
New Breast Cancer Screening Guidelines Cause Division, Confusion, and Outrage
RE:Connect blogger Joni Watson discusses the new breast cancer screening recommendations that were released by the U.S. Preventive Services Task Force in late November 2009. Get an overview of the guidelines, share what your patients are asking you, and discuss how this has changed your practice at http://reconnect.typepad.com/recon-nect/2009/11/new-breast-cancer-screening-guidelines-cause-division-confusion-outrage.html. ✱
You Tell Us, Readers!Find out how nurses are raising funds to pay for patient needs not
being met through insurance. Read the January You Tell Us responses online at www.ONSConnect.org.
To reply to the next You Tell Us question, “How has membership in ONS’s special interest groups influenced your practice?” e-mail Managing Editor Elisa Becze at [email protected] by February 1. Responses will be included in ONS Connect’s April 2010 “You Tell Us” department. Submissions should be approximately 125 words and may be edited for clarity and space. ✱
Candidate Change for the 2010 ONS ElectionDarcy Burbage, RN, MSN, AOCN®, CBCN, has voluntarily withdrawn
her candidacy for the ONS director-at-large position. For a current list of candidates for the 2010 ONS Election, visit www.ons.org/Membership/Election/Candidates. ✱
January 2010 ONS CONNECT 5
10 UP FRONT When Patients Can’t
Afford to Have Cancer Continually, we hear about the financial and insurance crises and how they are affecting patients. Read how two ONS members are responding to patients’ financial needs at their workplaces.
14 FIVE-MINUTE IN-SERVICE Transdermal Medication
Delivery Helps Prevent CINVPatients previously unable to use oral or par-enteral antiemetics may find relief with transdermal CINV delivery systems.
16 NEW TREATMENTS, NEW hOPEDaily Doses of Imatinib May Improve
Survival for Children With High-Risk LeukemiaA Children’s Oncology Group study has found that continuous expo-sure to imatinib for 2.5 years increases survival rates to 87% with no significant side effects.
17 A CLOSER LOOKProlonged Hospitalization in Patients
With Cancer: How Long Is Too Long?Increased length of stay puts patients at higher risk for infections and is associated with higher healthcare costs.
ONS Connect is indexed in the Cumulative Index to Nursing and Allied Health Literature®, MEDLINE®, and the International Nursing Index.The Oncology Nursing Society and the ONS Connect Editorial Board do not assume responsibility for the opinions expressed by authors. Editorials represent
the opinions of the authors and not necessarily those of the Oncology Nursing Society. Acceptance of advertising or corporate support does not indicate or imply endorsement by ONS Connect or the Oncology Nursing Society. Mention of specific products and opinions related to those products do not indicate or imply endorse-ment by ONS Connect or the Oncology Nursing Society. Web sites published in ONS Connect are provided for information only; the hosts are responsible for their own content and availability.
Postage Privileges: Periodical rates paid at Pittsburgh, PA, and at additional mailing offices.Postmaster: Send address changes to ONS Connect, Oncology Nursing Society, 125 Enterprise Drive, Pittsburgh, PA 15275-1214 USA. Published monthly by
the Oncology Nursing Society, P.O. Box 3510, Pittsburgh, PA 15230-3510 USA. Yearly subscription rates are $29.99 for individual nonmembers and $39.99 for institu-tions. As part of ONS membership dues, $4.53 are for a one-year subscription to ONS Connect. Vol. 25, No. 1.
ISSN: 1935-1623. Copyright © 2010 by the Oncology Nursing Society. Blanket permission for copying any material in ONS Connect is granted to ONS members.
ALSO IN ThIS ISSUE
6 ONSCONNECT.ORGGet a preview of what’s in store this month online with ONS Connect.
6 WEB CONNECTFind resources to help patients pay for cancer care.
7 EDITOR’S NOTE Help patients save costs by managing medications.
8 NURSING SAFETYPractice safe nursing with oral hazardous drugs.
8 CAPITOL CONNECTIONONS efforts to snuff out tobacco a success in 2009
9 JUST INThe latest news from the oncology field
18 WORKING FOR YOUONS Board resolves to help Society thrive in 2010.
18 CALENDAR OF EVENTSONS programs and deadlines for winter and spring
INSIDE
Printed on 10% postconsumer recycled paper. Please recycle this publication.
Check us out on the Web! Visit www.ONSConnect.org.
6 ONS CONNECT January 2010 January 2010 ONS CONNECT 7
T he cost of cancer treatment is a concern for many patients and
their families. Even patients with insur-ance may face difficulty with treatment costs. In a national survey of patients with cancer and their families, 25% de-pleted all or most of their savings on cancer care, 33% reported problems paying cancer bills, and 27% of those insured delayed or did not obtain can-cer care because of costs (USA Today, Kaiser Family Foundation, & Harvard School of Public Health, 2006). The fol-lowing resources can help patients navi-gate and obtain assistance with the cost of cancer care.
• American Cancer Society: Health Insurance and Financial Assistance for the Cancer Patient (www.cancer.org/docroot/MIT/content/MIT_3_2X_Medical_Insurance_and_Financial_Assistance_for_the_Cancer_Patient.asp?%3e)
• American Society of Clinical On-cology: Managing the Cost of Can-cer Care (www.cancer.net/patient/All+About+Cancer/Managing+the+Cost+of+Cancer+Care)
• Cancer Financial Assistance Coali-tion (www.cancerfac.org)
• National Cancer Institute: Financial Assistance and Other Resources for
People With Cancer (www.cancer.gov/cancertopics/factsheet/Support/financial-resources)
• National Coalition for Cancer Sur-vivorship (www.canceradvocacy.org/resources/financial.html)In addition to the resources listed, most
pharmaceutical companies have patient assistance programs, so be sure to check out manufacturers’ Web sites for financial assistance with specific drugs. ✱
USA Today, Kaiser Family Foundation, & Har-vard School of Public Health. (2006). Toplines: National survey of households affected by can-cer. Retrieved November 10, 2009, from http://www.kff.org/kaiserpolls/upload/7590.pdf
WEBCONNECT
Find Resources to Help Patients Pay for Cancer Care [By Deborah Braccia, RN, DNSc, MPA, OCN®, ONS Web Site Editor]
ONSCONNECT.ORG
Don’t Miss These Great Articles at www.ONSConnect.org
You Tell UsONS Connect readers share how
they are raising funds to pay for patient needs not being met through insurance.
Caregiver CareIt’s never too early—or too late—to plan for retirement.
Get tips on managing your retirement accounts from the secretary of the ONS Foundation Board of Directors, a certi-fied financial planner.
ONS ElectionBe a force in ONS by casting your vote in the ONS annual
elections. Read how you may be able to help your chapter win an award for the highest voting percentage.
Staying on TopMove up the ladder with the help of these ONS resources.
Question MarkCan you tell me more about
Cancer and Careers? Find out how ONS members can use this organi-zation’s resources.
ONS 10x10 CampaignLearn how you can get involved in helping ONS achieve
its goal of 40,000 members in 2010.
ONS Board BriefsThe ONS Board approves a balanced budget for 2010; get
additional highlights from the October and December Board meetings.
January 2010 ONS CONNECT 7
H ow many times have you admitted patients to your unit or conducted an assessment
of patients in your clinic or physi-cian’s office and reviewed their cur-rent medications? You ask patients and caregivers to bring all of their current medications with them, and you ensure that the medical record matches those bottles. This verification of medications is a standard nursing practice.
But do you also really look at the list to ensure that the patients still need every medication? Do you consider the
potential interactions of the medica-tions? And do you ask patients how they are tolerating the medications?
I recently was with a friend and her husband during an emergency room admission, transfer to and discharge from a nursing home, and readmission to and discharge from the hospital. My friend, who has several chronic conditions, was experiencing severe side effects of chemotherapy. With each admission and discharge, more pre-scriptions were added. None of the physicians involved were comfortable with changing medications ordered by another specialist.
After my friend’s last discharge, I set up the medications in a pill box for easier administration by family mem-
bers and was amazed that the number of pills to be taken per day was 25. The drawer of prescription bottles from the past six months of treatments con-tained more than 40 bottles. It was not surprising that my friend’s appetite was completely obstructed by the sheer number of pills and capsules to be con-sumed. Her husband was overwhelmed with the number of bottles and refills to keep track of.
We face continued health insurance constraints and an economy that has not yet recovered. Nurses can help each patient manage their prescriptions to increase efficacy of medications and decrease costs caused by unnecessary prescriptions. It takes extra time to write a prescription for a small amount of a new medication, follow up with a telephone call to assess response, and then provide a full prescription for an effective medication. It also takes extra time to consider potential interactions and assess tolerance. But these small steps, done consistently one patient at a time, can improve response and decrease costs.
My friend is a nurse who has the ability to sort out her medications for herself. Her appetite improved, and she feels much better. However, most of our patients do not have the knowledge needed to manage complicated medica-tion regimens. As you read the issues in our feature article regarding dealing with the rising costs of cancer care, remember that medication management is one area where you can advocate for your patients on a daily basis. ✱
Oncology Nurses Can Help Patients Save Costs by Managing Their Medications[By Debra M. Wujcik, RN, PhD, AOCN®, Editor]
EDITOR’SNOTE
Debra M. Wujcik, RN, PhD, AOCN®, Editor
These small steps, done consistently one patient at a time, can improve response and decrease costs.
8 ONS CONNECT January 2010 January 2010 ONS CONNECT 9
I n 2009, the United States witnessed a transformation on how tobacco is
handled in this country. On February 4 last year, President Obama signed into law the State Children’s Health Insur-ance Program (SCHIP). This legislation expanded healthcare coverage to mil-lions of children, and it also increased the federal cigarette tax by 61 cents a pack. Then, on June 22, President Obama signed the Family Prevention and Tobacco Control Act (S. 982) into law. This legislation gives the U.S. Food and Drug Administration authority to regulate the production, sale, distribu-tion, and marketing of all tobacco prod-
ucts, with emphasis on how tobacco is marketed toward children, including banning flavored cigarettes.
ONS is actively involved in the imple-mentation of this legislation. In Sep-tember, we sent comments to the FDA (www.ons.org/LAC/HealthPolicy/media/ons/docs/LAC/pdf/correspondence/111/Regulation-of-Tobacco-Products.pdf) speaking to priorities for oncology nurs-es and sharing our position on Nursing Leadership in Global and Domestic To-bacco Control (www.ons.org/Publica-tions/Positions/Tobacco).
Also, ONS helped support others in the public health community in op-
posing a lawsuit by the tobacco in-dustry. In November, a federal judge rejected an effort by tobacco compa-nies to block provisions in the Family Prevention and Tobacco Control Act (www.tobaccofreekids.org/Script/Dis-playPressRelease.php3?Display=1179).
However, work still needs to be done. A recent study from the Centers for Dis-ease Control and Prevention showed that tobacco use in the United States has stopped declining (www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm). Thank you for your advocacy in 2009 and your continued partnership in 2010 and beyond. ✱
CAPITOLCONNECTION
ONS Efforts to Snuff Out Tobacco Were a Success in 2009 [By Leslie Greenberg, RN, MSN, OCN®, ONS Health Policy Manager]
The number of currently available hazardous oral drugs is increas-
ing and now includes small molecules and hormones in addition to traditional agents such as cyclophosphamide. (For a full list of oral hazardous drugs, visit www.ONSConnect.org.) Nurses are pre-sented with unique safety challenges in handling these medications.
General guidelines should be followed for handling hazardous oral drugs.• Use double gloves.• Wear a face shield if there is a poten-
tial for spraying, aerosolization, or splashing.
• Crushing or manipulating should be done in a biologic safety cabinet.
• Wash hands thoroughly with soap and water after removing gloves.
• Spoons, oral syringes, disposable medicine cups, or other equipment used to administer the agents must be discarded as hazardous waste. Some medications cannot be crushed,
often because of timed-release or en-teric coatings. When crushing hazard-ous oral drugs is necessary for use in nasogastric or gastric tubes or to mix with food, nurses may be at extremely high risk for exposure.
A recommended method for dissolv-ing and administering a capsule by syringe is to remove the plunger from the oral syringe and place the capsule
inside. Replace the plunger, draw warm fluid into the syringe, and allow the capsule to dissolve. The suspension can be administrated orally or via feed-ing tube.
The Institute for Safe Medical Prac-tices emphasizes the use of specialized oral syringes (not standard slip tip or luer-lock syringes) for administering oral hazardous drugs to prevent inad-vertent IV administration. For more in-formation, visit www.ismp.org/Newslet-ters/acutecare/articles/20091022.asp.
Do you have a nursing safety is-sue you’d l ike to see addressed in this column? Send an e-mail to [email protected] . ✱
NURSINGSAFETY
Practice Safe Nursing With Oral Hazardous Drugs [By Seth Eisenberg, RN, BSN, Contributing Editor]
January 2010 ONS CONNECT 9
JUSTIN
Marital Separation May Affect Cancer Survival
Although married people are more likely to survive cancer, those who
are separated at the time of diagnosis do not live as long as widowed, di-vorced, or never-married patients.
Researchers said that their results suggest that the stress associated with marital separation may compromise an
individual’s immune system and con-tribute to susceptibility to cancer. The researchers analyzed data on 3.8 mil-lion people diagnosed with cancer from 1973–2004. They found that people who were married had a 63% chance of surviving five years, compared to 45% for people who were separated.
The researchers looked at 5- and 10-year survival rates for married, wid-owed, divorced, and never-married pa-tients as well as those going through a separation at the time of diagnosis. After married patients, never-married patients had the best outcomes, fol-lowed by those who had been divorced and then those who were widowed.
Sprehn, G.C., Chambers, J.E., Saykin, A.J., Kon-ski, A., & Johnstone, P.A. (2009). Decreased cancer survival in individuals separated at time of diagnosis: Critical period for cancer pathophysiology? Cancer, 115(21), 5108–5116.
Aggressive Childhood Cancer Linked to Mutations
Researchers have found a gene that may be a new target for the treat-
ment of rhabdomyosarcoma (RMS), a
cancer that develops in the body’s soft tissues. RMS is the most common type of sarcoma in children. Although progress has been made in its treatment, less than 30% of children whose cancer has me-tastasized survive more than five years.
The gene produces a substance called fibroblast growth factor receptor 4 (FGFR4). Researchers examined FGFR4 gene expression in RMS tumors and
found that high levels of gene expression were associated with advanced disease, including metastasis, as well as poor patient outcomes. They then used ge-netic manipulation to block expression of the FGFR4 gene in human RMS cells. Suppression of FGFR4 gene expression slowed the growth of the cells in labora-tory experiments. In addition, when the cells were transplanted into mice, they grew more slowly and were less likely to spread to the lungs than cells with unsuppressed FGFR4 genes.
According to the researchers, these findings are the first to show that when FGFR4 is overactive, it plays a key role in the growth and spread of RMS and that the gene could be an important target for therapy in the future.
Vi, J.G., Cheuk, A.T., Tsang, P.S., Chung, J.Y., Song, Y.K., Desai, K., et al. (2009). Identifica-tion of FGFR4-activating mutations in human rhabdomyosarcomas that promote metastasis in xenotransplanted models. Journal of Clinical Investigation, 119(11), 3395–3407.
Liver Cancer Marker May Predict Prognosis
Asmall RNA molecule called miR-26 shows promise in predicting
survival and response to adjuvant in-terferon treatment in patients with he-patocellular carcinoma, according to a new study. The molecule is one of one of approximately 1,000 microRNAs in the human genome that are believed to regulate the activity of several hundred genes.
The researchers analyzed three in-dependent patient cohorts in which in-dividuals had undergone radical tumor resection for hepatocellular carcinoma. Cohort 1 consisted of 241 patients for whom microRNA microarray data were available. Cohorts 2 and 3 consisted of 214 patients drawn from prospective randomized, controlled trials of adju-vant therapy with interferon alfa. The researchers found that patients whose tumors had low miR-26 expression had poorer survival but were more likely to respond to adjuvant treatment with interferon alfa than patients whose tu-mors had high miR-26 expression.
Overall, patients with low levels of miR-26 did not live as long as patients with higher levels. The difference in survival was about four years. Although low levels of miR-26 were linked to poor prognosis, those patients were more likely to benefit from interferon as an adjuvant therapy. This group survived at least 7.7 years longer than patients with low levels of miR-26 who did not receive interferon therapy. ✱
Ji, J., Shi, J., Budhu, A., Yu, Z., Forgues, M., Roessler, S., et al. (2009). MicroRNA expres-sion, survival, and response to interferon in liver cancer. New England Journal of Medicine, 361(15), 1437–1447.
Contributing Editor Deborah McBride, RN, MSN, CPON®, is a staff nurse III at the Kaiser Permanente Oakland Medical Center and an assistant professor at Samuel Mer-ritt University in Oakland, CA.
[By Deborah McBride, RN, MSN, CPON®, Contributing Editor]
People who were married had a 63% chance of surviving five years, compared to 45% for people who were separated.
January 2010 ONS CONNECT 11
The headlines are ominous. The unemployment rate is climbing, standing at 10% in Novem-
ber 2009, up from 6.8% a year ago (Bureau of Labor Statistics, 2009). Companies, unsure of the economic recovery, are not hiring new workers. For every 1% increase in the unemployment rate, 1.1 million people lose their health insurance. Forty-six million adults younger than age 65 in the United States lack health insurance (Kaiser Family Foundation, 2008). In January 2009, the New York Times reported that states are seeing a 5%–10% increase in the Medicaid population (Sack & Zezima).
[By Susan Pillet, RN, CPNP, CPON®, Contributing Editor]
Oncology Nurses Help Remove Financial Barriers to Cancer Care
When Patients Can’t Afford
to Have Cancer
January 2010 ONS CONNECT 11
helping Patients Cope Financially
The stressors are adding up for patients with cancer. How do nurses help patients and families cope? “Often times, the financial catastrophe fami-lies experience is worse than the can-cer diagnosis,” says ONS member Jean Sellers, RN, MSN, OCN®. She gives the example of a woman whose husband was in the operating room undergoing a craniotomy for removal of a brain tumor. The woman had put off her own treatment for a brain tumor, but what she really needed right then was $50 to have food at home for her family during her husband’s hospitalization.
Sellers is the administrative direc-tor of the University of North Carolina
Cancer Outreach Program in Chapel Hill and is establishing nurse naviga-tors throughout her state. The program is funded by the state legislature and is currently starting in Dare County, a rural area in eastern North Carolina.
“I am based in Chapel Hill, but our commitment is to all the people of North Carolina. We have a number of leaders at our institution and in the state leg-islature who are committed to the suc-cess of this program,” Sellers says. “We identify barriers to care and use local resources to ensure that patients get needed treatments and provide educa-tion to others about the importance of preventive care.”
ONS member Lynley Fow, ARNP, AOCNP®, is an advanced oncology cer-
tified nurse practitioner who works in private practice in Kirkland, WA. She finds that patients without insurance may delay treatment because they fear they can’t afford it. She says that an advantage of private practice is that it does give physicians the ability to write off copays or payment for a visit.
“10%–15% of our patients have no insurance or poor insurance,” Fow says. It is unusual, though, for them to see patients lose their insurance during treatment.
Fow identifies infusion nurses as being on the front line for financial crisis. Patients spend longer times in an infu-sion suite and will often first share their financial concerns with the nurses there. Patients may be hesitant to tell the
Jean Sellers, RN, MSN, OCN®, says that the financial stress patients experience may be worse than the stress from their cancer diagnosis.
12 ONS CONNECT January 2010 January 2010 ONS CONNECT 13
medical team for fear of not receiving adequate treatment because of a lack of insurance. Infusion nurses can reassure patients that they will be provided with standard of care therapy and not denied because of lack of insurance.
“The only difference for patients without insurance is that their treat-ment takes place at the hospital rather
than the office. We don’t turn anyone away,” Fow says.
She says that her practice works as a team to care for patients. Social workers help patients apply for charity care or Medicaid. A financial counselor reviews copays and informs patients what the maximum out-of-pocket expense will be. “We share with patients the cost of their
chemotherapy so they are not shocked when they get the bill,” Fow says.
Her patients can also request a financial consult to look at their fam-ily’s budget to see if any expenses can be trimmed to help offset pharmacy copays, transportation for clinic vis-its, and over-the-counter medications. The pharmacy staff at Fow’s clinic help patients complete applications for patient assistance programs and advise them on using less expensive drugs to achieve the same results.
Sellers says that similar services are available in North Carolina. Patients expressing the need for financial sup-port must show their tax return. Their budgets also are assessed to see if any items can be trimmed. In addi-tion, social workers in Sellers’ program can give patients $25 gas cards. The employees hold bake sales to fund this service.
Programs That Offer Financial Aid
So, what can oncology nurses do to help their patients with financial concerns? “We look for local resourc-es to help patients in crisis,” Sellers says. “We’ve partnered with the health department, Salvation Army, and local hospitals and churches. For example, we had a patient whose car needed new brakes for her to have transportation for treatment appointments. We were able to find an organization in the local com-munity to pay for the brake repair.”
Fow’s workplace has a foundation that was established to provide patients with financial assistance. “The monies have come from fundraisers and patient bequests. We also use www.needymeds .org to find medication assistance for patients,” Fow says. She also advises patients about the $4 prescriptions offered at various local pharmacies.
Sellers recommends the Patient Advocate Foundation (www.patientad-vocate.org), a nonprofit organization
Where to Send Your Patients for Financial Aid Are you struggling to find sources of financial aid for your patients? Most
pharmaceutical companies offer patient assistance programs to income eli-gible patients and provide medications free or at a reduced cost. Check the product’s or manufacturer’s Web site to see if an assistance program is avail-able for a particular prescription.
In addition, several national organizations offer financial aid for copays or practical financial needs such as child care. CancerCare (www.cancercare.org), the Leukemia and Lymphoma Society (www.lls.org), and the Patient Advocate Foundation’s Copay Relief Program (www.patientadvocate.org, www.copays.org) are all possible sources of aid for your patients. Patients usually must meet cer-tain guidelines pertaining to household income and cancer diagnosis.
Lynley Fow, ARNP, AOCNP®, says that some patients without insurance may delay needed treatments for fear they can’t afford them.
January 2010 ONS CONNECT 13
Kathy Lopeman, RN, OCN®, is the oncology/infusion charge nurse at Central Peninsula Hospital in Soldotna, AK.
Apersonal experience with cancer inspired me to improve care for patients with cancer. My mom died from colon
cancer, and as a medical/surgical nurse, I could see where change was needed for people being treated. After much hard work, lots of studying, and oncology training, I was able to establish the unit where I now work.
To support our patients in need, we have created a unique fundraiser: our annual Way Out Women snow machine ride. The 2010 ride will be our sixth. To add to the festivities, we always have team themes, complete with costumes. Partici-pants obtain monetary donations from friends, family, cowork-ers, and community members. The last Saturday in February, the costumes are donned, the snow machines are fueled up, and we rev up the engines for a 50-mile ride in the beautiful Caribou Hills. After the ride is complete, we tally up the dona-tions collected, vote on costumes, and have a great lunch.
But the fun isn’t over yet! We then award prizes for the largest amount of donations collected and the best costumes. In addition, a silent auction starts the night before at the
meet and greet, which is completed on Satur-day evening. Last year, we started a new event: the Wild and Wooly Bra contest. Bras are made by participants and then auctioned off. It was a great success and raised more than $600.
We are proud that dur-ing the past five years, we have raised more than $110,000 through these charity events. The money is distributed to pa-tients in need in the form of $1,000 grants. We have assisted folks from ages 8–80 and helped with practical things such as food, transportation, lodging, utilities, and more.
All of the donations made are tax deductible through our health foundation. All of our prizes are donated and we have no administrative costs, so all of the proceeds benefit the patients. We’ve found that this is a great opportunity to com-bine our love of snow machines and help out our community. I would challenge all nurses to join our event. ✱
[OnE nurSE’S PErSPEctivE] How Have Nurses Come Together to Help Patients in Need? Alaskan Nurses Raise $110,000 Through Snow Machine Fundraiser
that provides a link for patients between their insurance company, employer, and/or creditors. The American Cancer Society offers a Road to Recovery pro-gram that can help with transportation.
She also finds that local communities have much to give. Establishing rela-tionships and building trust with local groups are critical to helping patients find assistance close to home.
“We’ve developed a community care team called Hands of Hope,” Sellers says. “This is a volunteer program that helps community members learn about cancer and how they can support patients and families facing this diag-nosis. The program collaborates with existing community programs so ser-vices are not duplicated. Most impor-
tant, it’s about teaching volunteers the difference they can make in the life of a patient and family on the cancer jour-ney by simply understanding what may be their needs.”
Program volunteers learn effective communication, the art of listening, and information about cancer, cancer pre-vention, and patient advocacy. Sellers says the goal is to have similar pro-grams available throughout the state of North Carolina.
“Recently we were invited to develop a mini volunteer orientation program for local high school students,” Sellers adds. “This is exciting because we will have the opportunity to provide stu-dents with skills that will follow them throughout their lives.” ✱
Bureau of Labor Statistics. (2009). Labor force statistics from the current popula-tion survey. Retrieved December 14, 2009, from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet?data_tool=latest_numbers&series_id=LNS14000000
Kaiser Family Foundation. (2008). Medicaid, SCHIP and economic downturn: Policy chal-lenges and policy responses. Retrieved Octo-ber 30, 2009, from http://www.kff.org/medic-aid/upload/7770ES.pdf
Sack, K., & Zezima, K. (2009, January 21). Grow-ing need for Medicaid strains states. New York Times. Retrieved October 30, 2009, from http://www.nytimes.com/2009/01/22/us/22medicaid.html
Contributing Editor Su-san Pillet, RN, CPNP, CPON®, is an advanced practice nurse for the Cancer Institute of New Jersey in New Brunswick.
14 ONS CONNECT January 2010 January 2010 ONS CONNECT 15
A lthough antiemetics can be ef-fective in preventing nausea and
vomiting from moderate to highly emo-togenic chemotherapy, some patients are unable to use the drugs because of route of administration. Parenteral antiemetics require an IV device and a healthcare professional or specially trained caregiver to administer. Oral antiemetics require patients to have a functioning gastrointestinal system, to adhere to an administration schedule, and to be able to swallow and retain the drug.
Transdermal antiemetic delivery of-fers a new alternative for patients pre-viously unable to take or tolerate par-enteral or oral antiemetics. This type of delivery system administers medication continuously through the skin, bypass-ing the gastrointestinal system alto-gether and ensuring a constant rate of administration and prolonged action. Few side effects and risks exist, and administration requires no specialized nursing care. Granisetron transdermal system (Sancuso®) is the first trans-dermal medication indicated for use in chemotherapy-induced nausea and vomiting. In her article in the Decem-ber 2009 issue of the Clinical Journal of Oncology Nursing, Schulmeister de-scribes the nursing and patient consid-erations for use of transdermal delivery of granisetron.
AS SEEn in thE CliniCal Journal of onCology nursing
Transdermal Medication Delivery Helps Prevent CINV[By Elisa Becze, BA, ELS, ONS Staff Writer]
Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Granisetron Transdermal System: A New Option to Help Prevent Chemotherapy-Induced Nausea and Vomiting” by Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN, which was featured in the December 2009 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at [email protected]. Photocopying of this article for educational purposes and group discus-sion is permitted.
FIVEMINUTEINSERVICE
Key DefinitionsGranisetron: a serotonin subtype 3 (5-HT3) receptor antagonist indicated to prevent nausea and vomiting from moderate to highly emetogenic chemo-therapy; can be administered orally, intravenously, or via a new transdermal patchTransdermal medication delivery: provides systemic therapy by passive diffusion of medication through the skin
January 2010 ONS CONNECT 15
Transdermal Delivery SystemsThe first transdermal medication de-
livery system, a skin patch that adminis-tered scopolamine for motion sickness, was introduced in 1981. However, trans-dermal systems were not in mainstream use until the nicotine patch was ap-proved in 1996. Since then, transdermal delivery systems have been developed and approved for several medications, including clonidine, estradiol, fentanyl, lidocaine, and testosterone. Granisetron was approved for transdermal delivery in 2008.
Benefits of transdermal delivery in-clude• Long periods of continuous medica-
tion delivery to distant sites of action• Avoidance of first-pass metabolism• Ability of medication to directly enter
the circulatory system• Minimal adverse effects (effects have
been consistent with those seen with other delivery systems).Currently, two types of transdermal
patches exist: reservoir-type and matrix-type. Both types contain a protective outer seal, a medication compartment, and a release liner. For reservoir patch-es (sometimes called a “ravioli”), the three components are separate layers. A medication reservoir is contained be-tween the protective backing membrane and the rate-controlling microporous membrane. For matrix patches, all three components are contained in one layer, allowing for a smaller, thinner patch.
In both designs, the rate of adminis-tration is controlled by the microporous release membrane. The rate of release is not affected by skin texture, thick-ness, pigment, or age—generally all adults will absorb the medication at the same rate. Both types of patches can be applied to most areas of the body (i.e., arms, thighs, back, and abdomen); how-
ever, hair growth may affect adherence, so most manufacturers recommend up-per-outer arm placement.
Granisetron Transdermal Delivery System
Granisetron transdermal patches are of the matrix variety and are designed to deliver 3.1 mg of the drug per 24 hours for up to seven days (for a total of 21.7 mg). However, the patches deliver only about 66% of the drug they contain, so each patch is actually loaded with a to-tal of 34.3 mg of granisetron to allow for the 34% loss.
Two double-blind safety studies found that use of granisetron was associated with side effects in 8.7% of patients who wore the patch and 7.1% of pa-tients who received the drug orally. In both groups, the most common side ef-fect was constipation (5.4% and 3%, re-spectively). The patch had no clinically significant effect on blood pressure or heart rate or rhythm. Patch application site reactions were rare. Efficacy stud-ies of the two routes of administration demonstrated that the drug was effec-tive in 60% of patients who wore the
patch and 64.8% of patients receiving oral granisetron. Schulmeister (2009) noted that no safety and efficacy stud-ies have been completed in patients younger than 18.
The patch should be applied to dry, intact skin on the upper-outer arm 24–48 hours before chemotherapy ad-ministration and should be removed at least 24 hours after completion of chemotherapy. Gloves do not need to be used for handling the patches. Used patches should be discarded in house-hold waste. To prevent accidental ex-posure to residual medication by fam-ily members and pets, instruct patients to fold the patch in half so it sticks to itself and to wrap it in a paper towel before disposing. For additional patient education points related to granisetron patches, see Figure 1.
For more information on the granis-etron transdermal delivery system, re-fer to the full article by Schulmeister (2009). ✱
Schulmeister, L. (2009). Granisetron transdermal system: A new option to help prevent chemo-therapy-induced nausea and vomiting. Clinical Journal of Oncology Nursing, 13(6), 711–714.
Figure 1. Patient Education for Granisetron Transdermal Delivery Systems
• Transdermal patches are waterproof; however, excessive sweat or moisture may cause them to peel off the skin.
• Hot, steamy environments (e.g., hot tubs, saunas) should be avoided while wearing a transdermal patch.
• Do not apply bath oils or skin moisturizers or use soaps with a high cream content in the area where a patch will be or has been applied.
• Cover the patch with clothing and avoid direct sunlight, sunlamps, and tan-ning beds while wearing the patch and for 10 days following its removal.
• Set up a reminder system to ensure the patch is removed at the prescribed interval.
• When talking to other healthcare professionals or pharmacists, transder-mal patches should be listed among the medications you are taking.
Note. Based on information from Schulmeister, 2009.
16 ONS CONNECT January 2010 January 2010 ONS CONNECT 17
Adding continuous daily doses of imatinib to regular chemotherapy
doubled three-year survival rates for chil-dren with Philadelphia chromosome–pos-itive acute lymphoblastic leukemia (Ph+ ALL), a high-risk type of leukemia, a new study concludes.
The Children’s Oncology Group per-formed the study at 200 North American cancer centers and found that adding continuous exposure to imatinib for 2.5 years increased survival rates to 87% from 30%–35%. Survival rate is the length of time that a patient survived without a relapse and without develop-ing a new cancer. According to the re-searchers, the drug was well tolerated and had no significant side effects.
Multiple types of ALL exist, and each responds differently to treatments. Ph+ ALL involves genetic mutations on two specific chromosomes and doesn’t re-spond well to chemotherapy. The stan-dard treatment is blood and marrow transplantation, a life-saving procedure but one that is associated with a high risk of complications.
Using imatinib in combination with traditional chemotherapy may increase survival time enough so that blood and marrow transplantations are no longer necessary. Imatinib is a pill that is used to treat some adult leukemias and gas-trointestinal cancers. It binds to a spe-cific protein in cells and prevents it from proliferating.
In this study, 92 children, adolescents, and young adults aged 1–21 with Ph+ ALL received four weeks of standard che-motherapy and then were assigned to five
different groups that received imatinib for 42, 63, 84, 126, or 280 days. After treatment, all of the patients received maintenance therapy. The group that re-ceived imatinib for more than 280 con-tinuous days had survival rates of 87%, more than twice that of the histologic control group’s 35% survival rate. The groups that received imatinib for 84 and 126 days showed moderate improvement in survival rates, whereas the groups re-ceiving the drug for 42 and 63 days had the same survival rates as current stan-dard treatments. A comparison group of 21 patients with Ph+ ALL was treated with blood and marrow transplantation fol-lowed by six months of imatinib but did not have an increased sur-vival rate.
The researchers plan to obtain five-year survival data and then conduct a larger study to compare imatinib and chemotherapy with blood and mar-row transplantation to see whether the drug regimen can replace transplantation. ✱
Schultz, K.R., Bowman, W.P., Aledo, A., Slayton, W.B., Sather, H., Devidas, M., et al. (2009). Im-proved early event-free survival with imatinib in Philadelphia chromosome-positive acute lymphoblastic leukemia: A children’s oncology group study. Journal of Clinical Oncology, 27(31), 5175–5181.
Contributing Editor Deborah McBride, RN, MSN, CPON®, is a staff nurse III at the Kaiser Permanente Oakland Medical Center and an assistant professor at Sam-uel Merritt University in Oakland, CA.
NEWTREATMENTSNEWhOPE
Daily Doses of Imatinib May Improve Survival for Children With High-Risk Leukemia [By Deborah McBride, RN, MSN, CPON®, Contributing Editor]
The group that received imatinib for more than 280 contin-uous days had survival rates of 87%, more than twice that of the histologic control group’s 35% survival rate.
Enhance Your
Journal Experience!
Oncology Nursing
Forum Podcast SeriesSimply go to www.onsforum.org and click on the podcast link.
F o r u m®Oncology Nursing
An official journal of the oncology Nursing Society www.onsforum.org
167 Body Image and Prostate Cancer
175 Survivor Loneliness After Breast Cancer
185 Predictors of Lymphedema After Surgery
194 Fatigue and Physical Activity in Older Patients
203 Gay and Lesbian Patients With Cancer
209 Quality of Life and Fatigue in Multiple Myeloma
217 CAM Knowledge and Attitudes
225 Management of Temozolomide Toxicity
Volume 36, Number 2 • March 2009
232 Reducing Bloodstream Infections in Children
ONLINE EXCLUSIVE ARTICLES Strategies for Coping With Taste Changes
Surveillance in Women Undergoing BRCA Testing
Patient-Centered Communication
Mammogram Use in Korean American Women
Perceptions of Patient Knowledge in Decision Making
Consolation in Incurable Cancer
lmCover 0209.indd 1 02/18/2009 3:19:50 PM
January 2010 ONS CONNECT 17
Hospitalization is often inescapable for patients with cancer. Depend-
ing on the type of malignancy, average length of stay (LOS) can vary widely. According to the 2006 National Hos-pital Discharge Survey by DeFrances, Buie, and Golosinskiy (2008), the aver-age LOS was 6.5 days for patients with a first-line diagnosis of malignant neo-plasm and 7.8 days for malignant neo-plasms involving the large intestines or rectum. For patients with a hematologic malignancy who did not have renal com-plications or renal dialysis, the mean to-tal cost was $13,947 for a 7.4 day LOS (Candrilli et al., 2008).
LOS also may vary by age, gender, and reason for admission. Although admit-tance may be for a specific treatment such as induction chemotherapy or surgery, adverse events such as central venous catheter infections and treatment-related complications such as tumor lysis syn-
drome, febrile neut ropen ia (FN), or acute renal failure can result in significantly prolonged hos-pitalizations. According to Candrilli et al. (2008), acute renal failure re-quiring dialysis increases LOS f r o m 7 . 4 t o 17.6 days and increases cost from an aver-
age of $13,947 to $44,619. Besides caus-ing emotional distress for patients and the high cost of prolonged hospitalization, a longer stay is associated with acute hospital mortality and mortality follow-ing admission to the intensive care unit (Hampshire, Welch, McCrossan, Francis, & Harrison, 2009).
According to Nirenberg et al. (2006), patients admitted with FN are at in-creased risk for adverse events such as acquiring multidrug-resistant patho-gens. Additionally, avenues such as IV antibiotic administration and diagnostic procedures put patients at increased risk, and the risk also increases with each hospitalization. Nirenberg et al. reviewed a multicenter, retrospective study of 55,276 patients who were ad-mitted for FN and experienced one com-plication during the hospitalization and found that the average LOS increased to 11.2 days.
On an institutional level and for in-dividual oncology nurses, the role in decreasing adverse events associated with prolonged hospitalizations in-volves evidence-based nursing care, continuing nursing research, and ongo-ing nursing education. For example, hematopoietic colony-stimulating fac-tor (CSF) such as filgastrim and pegfil-gastrim has been the single-most useful pharmacologic intervention in reducing the overall adverse events (Nirenberg et al., 2006). National practice guide-lines can help identify patients who are high risk for FN and who would benefit from CSF. Day-to-day nursing opera-tions also may decrease hospital LOS, including practicing good hand hygiene, following laboratory trends, and track-ing intake/output status to monitor for conditions such as acute renal failure and tumor lysis syndrome. ✱
Candrilli, S., Bell, T., Irish, W., Morris, E., Gold-man, S., & Cairo, M.S. (2008). A comparison of inpatient length of stay and costs among patients with hematologic malignancies (ex-cluding Hodgkin disease) associated with and without acute renal failure. Clinical Lymphoma and Myeloma, 8(1), 44–51.
DeFrances, C.J., Buie, V.C., & Golosinskiy, A. (2008). 2006 National Hospital Discharge Survey. National health statistics reports. Re-trieved August 12, 2009, from http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf
Hampshire, P.A., Welch, C.A., McCrossan, L.A., Francis, K., & Harrison, D.A. (2009). Admis-sion factors associated with hospital mortality in patients with haematological malignancy ad-mitted to UK adult, general critical care units: A secondary analysis of the ICNARC Case Mix Programme Database. Critical Care, 13(R137), 1–28.
Nirenberg, A., Bush, A.P., Davis, A., Friese, C.R., Gillespie, T.W., & Rive, R.D. (2006). Neutro-penia: State of the knowledge part I. Oncology Nursing Forum, 33(6), 1193–1201.
ACLOSERLOOK
Prolonged Hospitalization in Patients With Cancer: How Long Is Too Long? [By Jennifer K. Mitchell, MSN, ANP-BC, GNP-BC, Contributing Editor]
18 ONS CONNECT January 2010 January 2010 ONS CONNECT 19
T ypically at New Year’s, we make resolutions, or goals, for the com-
ing year. The ONS Board of Directors has a similar process for setting goals and priorities, using multiple sources of information: your feedback about the organization and our programs and ser-vices; trends in cancer care, nursing, and associations; and health policy ac-tions. Here are the Board’s resolutions for 2010 and the next decade.1. We will be good stewards of ONS re-
sources and ensure that the organi-zation thrives.
2. We will be purposeful with our strate-gic priorities and encourage outside-the-box thinking, taking a wide view of issues and trends that influence the care of patients with cancer.
3. We will increase our influence in the health policy arena. We will monitor and influence healthcare reform to improve cancer prevention, access to treatment and clinical trials, and qual-ity of life of patients during and after treatment. We will advocate for inclu-sive legislative language so nurses are not invisible. As I write this, we know the U.S. House has passed a health-care reform bill, and the Senate hopes to pass its reform bill by the end of 2009.
4. We are a diverse membership and must ensure that the many constitu-encies in ONS have a way to express their ideas and needs. We will criti-cally evaluate services provided to our members to ensure that they add
v a l u e f o r o n c o l o g y nurses and patients.
5. As a team, we will model open communication and honesty in our discussions, look at all sides of every issue, and work cohesively on behalf of the Society.
6. We will use our vision and mission to guide our decision making.
7. We will ensure that ONS provides expert knowledge, evidence-based re-sources, and leadership development for all of our members.
Of course, individually, we each have goals as you do: Exercise more, eat less, and take more time to relax. Here’s to a great 2010! ✱
WORKINGFORYOU
ONS Board Resolves to Help the Society Thrive in 2010 [By Brenda nevidjon, RN, MSN, FAAN, ONS President]
CALENDAROFEVENTS
ONS Foundation Academic Scholarships
Application deadline: February 1Description: Bachelor’s, master’s and post-master’s certificate and doc-toral scholarshipsFor more information or to apply: Visit www.nursingawards.org.
16th International Conference on Cancer Nursing
Conference dates: March 7–10Location: Atlanta, GADescription: Collaborate with nurs-
es from around the world to over-come the challenges and demands that cancer nurses face everywhere. For more information: Visit www.isncc.org.
ONS 35th Annual CongressConference dates: May 13–15Location: San Diego, CAFor more information: Visit www.ons.org.
Upcoming Oncology Nursing Events and Deadlines
Contact ONS125 Enterprise Drive, Pittsburgh, PA 15275-1214 USA
Phone: 866-257-4ONS (toll free, U.S. and Canada) or +1-412-859-6100Fax: 877-369-5497 (toll free, U.S. and Canada) or +1-412-859-6165
E-mail: [email protected] • Web site: www.ons.orgOncology Calendar: http://onsopcontent.ons.org/Interactive/EventCalendar
Brenda Nevidjon,RN, MSN, FAAN
January 2010 ONS CONNECT 19
CAREERCENTER
To view ONS’s online Career Center, visit http://careers.ons.org.
To place a classified ad, contact Sharon Hampton at Anthony J. Jannetti, Inc.
East Holly Ave., Box 56Pitman, NJ 08071 USA
+1-856-256-2300, [email protected]://careers.ons.org
Ambulatory Care NursesPractice nursing in an environment that sup-
ports your professional growth and development. Memorial Sloan-Kettering Cancer Center ambula-tory care nurses are an integral part of a unique practice model that contributes to our reputation for excellence in patient care. New and expanded programs have created additional positions in New York City, Long Island, Westchester, and New Jersey in the following treatment areas.
Office practices: In collaboration with des-ignated attending physicians specializing in a specific disease, office practice nurses provide comprehensive professional nursing care to this defined patient population. A significant compo-nent of the role is care coordination across the continuum through office visits, telephone triage, and electronic communication.
Treatment suites: Work collaboratively with designated physicians and in partnership with office practice nurses to provide patient educa-tion, assessment, and symptom management to a defined patient population. Treatment unit nurses administer standard chemotherapy regimens as well as cutting-edge treatment to patients on clinical trials.
Both areas require a New York or New Jersey RN license and a minimum of one to two years of current related clinical experience. Chemotherapy certification is preferred for chemotherapy posi-tions—or we will educate.
We offer modified work schedules and an excel-lent compensation package, including tuition reimbursement. For consideration, please apply online at www.mskcc.org/jobs. EOE/AA
Tacoma, Washington—Palliative MedicineMultiCare Health System is searching for a
full-time ARNP to work in our palliative medicine program. Candidates should have a minimum of three years’ experience with at least two years’ experience in palliative medicine, hospice, or oncology. The practice is conveniently located on the main campus of our 391-bed tertiary care center with a 43-bed dedicated inpatient oncology medical-surgical unit.
Working just 30 miles south of Seattle, on the shores of Puget Sound, you’ll experience the best of Northwest living, from big city ame-nities to the pristine beauty and recreational opportunities of the great outdoors. Excellent compensation, a full array of benefits, and a great location make for an exciting opportu-nity. Please visit our Web site to apply online at www.blazenewtrails.org, e-mail your curriculum vitae to [email protected], or fax your curriculum vitae to 866-264-2818. Please refer to opportunity #7292 when responding. MultiCare Health System is proud to be a drug-free workplace.
Pacific Northwest, South Seattle Area Tacoma, Washington
MultiCare Health System is searching for a full-time ARNP to work with our gynecologic oncolo-gist providing pre- and postoperative care, round-ing on patients in the hospital, and providing first assist in surgery. The MultiCare Regional Cancer Center is a network affiliate of the Seattle Cancer Care Alliance. The practice is conveniently located on the main campus of our 391-bed tertiary care center with a 43-bed dedicated inpatient oncology medical-surgical unit. Working just 30 miles south of Seattle on the shores of Puget Sound, you’ll experience the best of Northwest living, from big city amenities to the pristine beauty and recreation-al opportunities of the great outdoors. Excellent compensation, a full array of benefits, and a great location make for an exciting opportunity.
Please visit our Web site to apply online at www.blazenewtrails.org, e-mail your curriculum vitae to [email protected], or fax your curriculum vitae to 866-264-2818. Please refer to opportunity 5802 when responding.
Do You Enjoy Writing and Reporting?Apply to Serve as an ONS Connect Contributing Editor
ONS Connect is seeking a contributing editor (CE) to serve on its editorial board. CEs work on many aspects of ONS Connect production, including writing and editing articles and determining publication goals, policies, and content.
Qualified applicants will have an oncology nursing background; experience with newslet-ter or magazine writing and production; strong reporting, writing, and editing skills; daily access to e-mail; the ability to consistently meet strict production deadlines; and the or-ganizational, planning, and interpersonal skills necessary to learn the role and work inde-pendently. The volunteer position requires a two-year time commitment, which includes regular writing assignments, travel to one planning meeting per year (with expenses paid by ONS), and participation in monthly conference calls. Applicants must be ONS members who are RNs.
Submit a letter of interest; current curriculum vitae; appropriate supporting materials, including writing samples; and the names of two references by March 30 to Editor Debra M. Wujcik, RN, PhD, AOCN®, via e-mail at [email protected] or fax at +1-615-341-4309.
www.ons.o
rg
Learn about the newest treatments and therapies
Get latest and greatest education on today’s oncology hot topics
Share ideas and experiences with your nursing peers
Take home practical information you’ll use in your daily practice
Expand your clinical skills
Visit the Congress area of
www.ons.org for more
details.
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