1. 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

2. 30-40 years ago: All of our oncology education came from the Bay Area Very little exposure to oncology nurses in our training Barbara 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.

4. 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????

5. If I were an oncology nurse I would be so depressed I would be crying all the time I would get involved with the patients and their families You must be an angel!! The BIG secret!!

6. Perry 2008 Creating moments of connection Making moments matter Energizing Moments (Cancer Oncology Nursing Journal, Spring 2008)

10. 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.

11. 1986 PSA enables early detection prostate cancer, Tamoxifen reduces breast cancer recurrence, global pain management guidelines 1989 Neupogen and Procrit 1990’s Laparoscopic surgery, 3-D radiation plans 1991 Zofran 70-90’s Sun exposure and melanoma, smoking and cancer

12. 1992-94Taxanes as a vital option for breast and ovarian cancer 1997 Rituximab 1998,2006 Herceptin 2001 Imatinib (Gleevec) for CML then GIST 2003 Scientists decode the human genome 2003,2004 EGFR targeted drugs for lung cancer, Bevacizumab

13. 2005 US launches efforts to map cancer genomes 2005 research sheds light on long-term problems of cancer survivors 2004,2008 cetuximab (Erbitux) and panitumumab (Vectibix) for colon cancer 2006 HPV vaccine prevents cervical cancer 2010 CT scanning reduces lung cancer deaths in heavy smokers 2010 ipilimumab (Yervoy) for melanoma 2010 Adding palliative care to standard treatment improves survival for advanced lung cancer

14. 22 year old male with Ewings Sarcoma spending days and weeks in the hospital. Very little verbal interaction with staff I would spend time in his room at night hoping that he would talk to me One rainy night Helped his parents cope with his dying 7am or 7pm What is my grief and what is their grief??

16. 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

18. 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 suffering Experiencing the precariousness of competing obligations Navigating the intricacies of hope and honesty Managing the urgency caused by waiting Straining to find the time Weighing risks of speaking out

19. Implications for practice Developing 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 heard Managers can create unit-based, ethics-trained champions who work with staff

20. 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 stress Symptoms include withdrawal from emotional scenarios at work, anger and decreased empathy Some worked through it and some left oncology.

21. Coined in the 1990 by Joinson Deep 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.

22. An accumulation of unresolved grief Symptoms can mimic burnout Emotional exhaustion Feeling of Inadequacy or failure Will become chronic unless remedied through grief resolution

23. 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

24. Rhythmic movement between energy expenditure (stress) and energy renewal (recovery) called oscillation Stress stimulates growth Recovery stimulates energy Rituals that promote this oscillation between stress and recovery

26. Immerse yourselves in the science of oncology Ask why like a 2 year old Find a mentor who will teach you what you don’t understand Teach someone else what you learned When 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.

31. Grief and end of life training and education Debrief with colleagues Altering Patient Care Assignments Retreats

32. Practice responsible selfishness

37. 18 year old male with lymphoblastic lymphoma Started chemotherapy Around cycle 3 admitted to ICU with 4 organ failure Survived and was cured of his cancer He 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