December 2014, VOL 5, NO 6

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Evidence into Practice

Barbara McHale, RN, BS, OCN, CBCN

Barbara R. McHale, BS, RN, OCN, CBCN 

My initial encounter with patients with cancer began at the end of my first year of nursing school. I was assigned to a medical–surgical floor, and was given a patient who had been newly diagnosed with advanced colorectal cancer. It was 1975, and our community-based hospital was in the process of creating an oncology service line with the help of a new group of medical oncologists.

The patient was brought to a private room, and the staff did not know how to handle her. There was no direction on giving patients such as her the care that they needed and deserved. At that instant, I knew my heart and soul would be given toward caring for these patients. I asked to be assigned to all patients who had a diagnosis of cancer.

After graduating from nursing school with a registered nurse degree, I was fortunate to be offered a part-time job at a 31-bed inpatient medical–surgical oncology floor. I supplemented my income by working part time in a private agency caring for oncology patients at home, with the goal of working full time on an oncology floor. I became involved with the American Cancer Society (ACS) of Rensselaer County, NY, and volunteered at breast cancer screenings and clinics. At that time, realizing the potential to increase my knowledge in the field, I ran in the Rensselaer County ACS Miss Hope Pageant and won the title—it was in 1978, and I was 22 years old.

A key feature of the New York State ACS Pageant was that the winner had the opportunity to complete a 6-week internship at Roswell Park Cancer Institute in Buffalo, NY. I continued to the state level of the pageant, where I was asked to give a presentation on my experiences with oncology nursing and my desire for further professional development. Once this was completed, the next step was an interview conducted by medical directors from various centers and nursing professors from across the state. I remember I was so scared; I did not know if I could get through the presentation, let alone be interviewed by a panel.

Once I started talking about my passion for oncology nursing and the impact I had on patients, I relaxed.True to my nature, once I started talking, I could not stop. I won the New York State ACS Miss Hope Pageant and continued working as a volunteer representative of ACS at the state level, volunteering at their breast screening clinics and assisting at community education presentations.

I continued to work in oncology inpatient and outpatient clinics, and enrolled in a bachelor of science program full time while working 80% of the time. My focus of study was premedicine, but I found the competitiveness of the program disheartening. I completed my degree, but decided to continue as an oncology nurse; my patients needed me, and I, in turn, needed them.

I married in 1983 and started to raise a family. I began to feel complete and wanted to progress in my oncology nursing career. Then, in one of life’s unexpected turns, my husband died in an accident, and I became a widow at 34 years old. I would never wish for anyone to lose a spouse, but the experience has led me to a bond with others who have had the same experience. I took every opportunity to grieve while caring for my young daughters, aged 3 and 4 years old, as well as myself.

After remarrying in 1992, I moved to Old Forge, NY, and began offering free consulting for patients with cancer. The nearest hospital was 70 minutes away from this community, and hospice was 80 minutes away. My desire to help patients with cancer spurred me to help the community develop a hospice volunteer program, and I started working for the hospice program per diem. There was also a need for a per diem registered nurse for Meals on Wheels. In addition, Herkimer County approached me about working part time for public health in the Old Forge area and its surrounding communities.

In 2004, I moved with my family back to Saratoga County, NY, worked at Saratoga Hospital in an inpatient oncology unit, and renewed my oncology nursing certification. I learned of an opportunity to manage a women’s health center and to do breast cancer navigation at Samaritan Hospital in Troy, NY. Intrigued with the idea, I interviewed for this position and met Sabrina Mosseau, RN, BS, OCN, who had developed the role and would be my manager. Although I wanted the position, my father was diagnosed at that time with metastatic renal cancer. Despite his illness, he encouraged me to continue with the interview process and accept the job if it was offered to me, knowing that in this position, I could help patients navigate through the fragmented healthcare system. My father died 2 weeks before my final interview, but I listened to his advice, and when I was offered the job, I accepted. I was later offered a full-time navigator position in the Cancer Treatment Center at Samaritan Hospital in 2009.

As I have settled into this position, I have realized that all of the experiences and “smaller” jobs along my journey have helped me to come full circle; these different roles and life events have helped to make me a well-rounded navigator. I am currently the only navigator at the cancer treatment center, and am grant-funded through philanthropists who believe in this role. I meet with patients with breast, colorectal, lung, and head and neck cancers, and at times I am asked to assist with patients with other cancer diagnoses at varying stages. I work with the entire cancer team to coordinate the care these patients need; coordinated care translates into better outcomes.

In my navigator position, I use data, metrics, and evidence-based standards of care to show a return on investment and promote my role. I strive for evidence-based standards of care and ways to measure the outcomes I have achieved. Because of this desire for quality outcomes and processes of improvement, I joined the Evidence into Practice Subcommittee of the Academy of Oncology Nurse Navigators (AONN) in March 2013. Through the mentoring and friendship of fellow navigators, such as Danelle Johnston, RN, MSN, OCN, CBCN, and Elaine Sein, RN, BSN, OCN, CBCN, I have been able to learn how to appropriately conduct research, publish abstracts, and network with many wonderful navigators.

After attending the AONN conference in 2011, I saw there was a need for process improvements for patients with head and neck cancer. At the AONN 2012 conference the following year, I presented an abstract and poster, “The Role of Navigation and Patient Education in the Treatment of Patients with Complex Cancers: Our Experience with Head and Neck Cancer Patients,” based on the great process we have at our center. We received the first place award in the patient education category, an honor that further emphasized the need to share our research, data, and metrics.

The high point of my career was the opportunity to pre­sent again the following year at the 2013 AONN conference in Memphis, TN, this time on the advanced navigation track. I was proud of the research I conducted on a rehabilitation program that was developed at the Samaritan Hospital Cancer Treatment Center and I knew other navigators could benefit from it.

Conclusion
In the years since 1975 when I encountered my first patient with cancer, my focus and love of nursing in oncology has never wavered. People ask me all the time, “Don’t you find it depressing?” Oncology is one of the most difficult and heart-wrenching nursing fields, but I receive so much in return from my patients and families. I have always felt that if I could help direct and make their cancer journey easier in any way, then I could make a difference in their lives.

As the dawn of a new year is upon us, I am grateful for the opportunities I have had, the patients who I serve, and the wonderful colleagues I have worked and connected with. I continue to look forward to what the future holds.

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