Practice Innovations, Change Management, and Resilience in Oncology Care Settings

Tracy K. Gosselin, PhD, RN, AOCN; Anne M. Ireland, MSN, RN, AOCN; CENP, Susie Newton, MS, RN, AOCN; AOCNS; Colleen O'Leary, MSN, RN, AOCNS


Oncol Nurs Forum. 2015;42(6):683-687. 

This column will focus on topics and interventions that concern oncology nurses as they strive to provide quality care for patients and families and support their own well-being. Oncology care settings have reported higher amounts of psychological morbidity for nurses, which can have a deleterious effect on their ability to care for patients and families. The following article, based on a 40th Oncology Nursing Society Congress session facilitated by the authors, highlights strategies and interventions that oncology nurses may use to support personal and professional well-being while managing change and practice innovations.

During the 40th Oncology Nursing Society Congress in Orlando, Florida, attendees of a session titled "Soarin' in Oncology—Innovation, Change, and Resilience" were asked to share their ideas on innovations in the areas of education, practice, administration, and research. In a short amount of time, the attendees shared more than 100 ideas ranging from innovative approaches to nursing education to new technologies to support streamlined care to smarter ways to collect data for clinical trials. Many of these innovations call for us to consider novel approaches to longstanding issues or completely alter how we approach challenges in our care environments. As we approach 2016, our commitment to advancing nursing practice and quality care for our patients must be at the forefront of our minds. Nursing's role in designing and implementing new innovations is integral to the advancement of healthcare delivery across the country.

Much of the change we will face is within the context of much larger technological forces that are happening globally, resulting in everything becoming more connected. In our homes, cars, cities, and workplaces, we are increasingly surrounded by "smart" technology with real-time analytics. In addition, much of this technology is getting smaller and more portable.

The technological term for this phenomenon is called the Internet of Things (IoT). The IoT "connects devices such as everyday consumer objects and industrial equipment onto the network, enabling information gathering and management of these devices via software to increase efficiency, enable new services, or achieve other health, safety, or environmental benefits" (Goldman Sachs, 2014, p. 2). As the future unfolds, the number of devices connected to the Internet is expected to increase exponentially from about 6 billion in the 2000s to 28 billion by 2020 (Goldman Sachs, 2014). Although we may think we are already living in a technology boom, the next wave is expected to dramatically change our personal lives, workplace productivity, and consumption.

In health care, we have arguably been slow to implement new technologies and resistant to automation. However, in the past five to seven years, we have become amenable to the notion that technological advancement will be a good thing for our industry and our patients. Although innovation in health care is sorely needed, most changes bring, at minimum, the need for revised workflow and education or, at maximum, a complete redesign of longstanding processes. Either way, change creates the need for nurses to unlearn old practices and procedures, which often results in anxiety, uncertainty, and distress for practitioners. In today's healthcare environment, a sense of urgency exists regarding changes that affect where and how we deliver care, as well as the environment in which we work. These changes are related to access to care, cost, reimbursement, outcome measures, and patient experience, and they affect each of us, regardless of role or title within our organizations. As oncology nurses, understanding the key drivers of change, as well as the role we choose to play when it comes to change (i.e., driver, implementer, enabler, and/or recipient), is critical (Business Performance Pty Ltd, 2015). The range of emotions we may feel can cause distress and hamper or accelerate our ability to remain resilient.

Creating programs to support resilience of all team members is essential. One example is the use of shared governance, which was designed with the intention of giving all nurses input into the decisions that affect their work and work environment. Gaining input or providing insight can often be a daunting process; however, during times of change, this process is sorely needed if we are to move forward for our patients, their loved ones, and one another. Opportunities to provide input can shape how we deliver care today and in the future. Our clinical, educational, research, and administrative leaders must work together to develop innovative models of self-care, as well as to implement and support those methods that have been shown to promote healthy work environments and positive well-being. Researchers have noted that, to develop such interventions, we need to know what motivates and sustains nurses (Raingruber & Wolf, 2015). In their work, Raingruber and Wolf (2015) identified three themes: (a) the importance of vulnerability and thankfulness by patients, (b) the feeling of spirituality associated with oncology practice and the use of prayer and compassion for self and others, and (c) the value of being present and recognizing priorities in their own lives. Based on this, some interventions to consider include having nurses share motivating experiences, connecting to a professional organization, and using highly experienced nurses to teach portions of academic content. Raingruber and Wolf (2015) also noted the need to highlight spiritual care of patients and self.

We also must become more innovative in how we learn and teach, and also how we engage with employees in the workplace. Do you ever feel like you cannot attend another boring meeting, sit through another PowerPoint® presentation, or try to "brainstorm" your way to a solution? Liberating Structures may be a refreshing option to this dilemma. Lipmanowicz and McCandless (2013), the creators of Liberating Structures, have crafted 33 methods of shifting patterns of interaction that make it possible to include everyone, promote innovation, and engage audiences, coworkers, and colleagues. Using Liberating Structures to facilitate small changes in practice can achieve big outcomes for nurses at all levels. The structures are easy to learn and can be incorporated into every meeting, project team, or conference. When team members are involved and engaged in learning and in the decision-making process, they accept the change and become champions for improving outcomes. In addition, in a learning environment, attendees grasp concepts and retain more of the information if they are active participants versus passive participants who simply listen to information that is presented. See Table 1 for an overview of several of the Liberating Structures techniques and steps to take for implementation.

During the 40th Congress session, the presenters used the Open Space, Crowd Sourcing, and Conversation Café techniques to actively engage the participants. Attendees were moving about the room, talking in small groups, writing on flip charts, and sharing their conversations with the larger group. These strategies turned the approach into one of facilitating rather than simply one of delivering information or lecturing. For participants, the session became more like an experience during which they both learned and shared their expertise.

Another vital aspect of engagement includes caring for ourselves. Nurses are trained to care for others but, sadly, often do not take the time to care for themselves with the same passion. The American Nurses Association (2015) defines a healthy nurse as one who "actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional wellbeing"(para. 1). When nurses practice self-care strategies, the benefits derived affect not only themselves and their families but also their work environment and, ultimately, their patients.

What are some things that nurses can do to care for themselves? When a group of nurses at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University in Columbus were asked this question, suggestions included doing stretches to Pharrell Williams's song "Happy," spending the day relaxing with pedicure and hair appointments, focusing attention on fun instead of on work while on vacation, balancing home and work life more closely, and enhancing humor throughout the day. Some innovative techniques that have been employed by healthcare facilities to promote self-care include putting different essential oils on cotton balls for nurses to use when they need energy or to relax; providing nutritional snacks and meals; having a space for nurses to get away for a few minutes to relax and regroup; giving chair, hand, or foot massages to nurses throughout the day; and offering areas for stretching and exercise. Many healthcare plans now have incentives for participating in self-care activities, such as exercise, improved nutrition, and good sleep habits. So, what are you going to do for yourself? A good exercise is to write down one thing that you promise to do for yourself. Put it somewhere where you will be able to see it on a daily or weekly basis, and track your progress. Another option may be to find someone who enjoys similar activities as you and will help to keep you motivated. You will be amazed at the difference little things make.

Change is inevitable and, in fact, needed in the healthcare arena. New technologies and innovative approaches to practice, education, research, and administration will undoubtedly help us realize the changes we need more quickly. Try using one of the Liberating Structures strategies in your next meeting or class as a way to engage the audience and promote more active participation. Beyond work, remember to take time for yourself, eat healthy and exercise, and try to keep all of the change and innovation in perspective.