Oncology Nursing Society Has the Power to Shape Health Care Policy: The President’s Address

SAN DIEGO—Power to shape health care policy and practice was on the minds of thousands of oncology nurses who attended the Oncology Nursing Society’s 26th Annual Congress. Roused by their leaders and a mariachi band marching down the aisle of the Convention Center at the opening session, more than 5,000 nurses from around the world proclaimed in unison, "We will be heard! We will be heard! We will be heard!"

"Power if used expertly can transform our practice," Paula Trahan Rieger, RN, MSN, CS, AOCN, president of the Society, told the nurses in her address.

One of the reasons nurses often feel powerless, she said, "is because we tend to hold the traditional view of power—that it is not shared and that managers are always powerful because they have the information." But things are changing, and today nurses have shared power plus access to information thanks to the Internet, said Ms. Rieger, a cancer detection specialist at the University of Texas M.D. Anderson Cancer Center.

She acknowledged that there is much to reinforce a feeling of powerlessness among nurses. "In our day-to-day lives, we often feel powerless to make changes in the system. We may feel tired, overworked, and underpaid."

She said that "our institutions can sometimes makes us feel powerless." Often nurses do not have a voice in how care is provided or when decisions are made.

The health care system in general represents a significant source of frustration to nurses, she said, "and often seems too large and powerful an institution for us to be able to effect change."

The traditional hierarchy in health care of powerful physicians and powerless nurses is changing, she said, "but we do still battle the old stereotypes and hierarchies of the past. Being a largely female profession, issues of gender and power may influence how we see ourselves and how others perceive us."

In spite of these obstacles, Ms. Rieger said, "I believe each of us holds power in a unique way. If we think of power as something to be shared, a whole new perspective begins to open." Knowledge, information, and connections are potential sources of power for oncology nurses individually and as a profession to share, she said, and the way to start is to select a goal.

"Then, analogous to the nursing process, we analyze the situation and determine the resources and power needed to meet that goal. Who in our group can contribute? Who might we collaborate with? Through expanding the power of collegiality, we can do more together than on our own."

Three Examples

Ms. Rieger cited examples of ONS chapters that had done just that: The Puget Sound chapter offers courses and grants for oncology research and internships to student nurses to work with the chapter. The New Orleans chapter, which received a special ONS award this year, established its own award in the name of a colleague for hospice nursing career development. The Greater Pittsburgh chapter started a summer camp for cancer patients and their caregivers. The chapter also raises money to fund the camp and recruits nurses and physicians to staff it.

The Clinical Trials Special Interest Group partnered with the National Cancer Institute and the Association of Oncology Social Workers and Novartis to introduce a training module for use in the NCI’s new Cancer Clinical Trials Education Program. And 4 years ago, the steering council of the Oncology Nursing Society proposed a leadership development program.

Ms. Rieger, noting that ONS has more than 29,000 members, said that the Society has power by virtue of its numbers and the expertise of its members. For example, ONS played an important role in helping to defeat the federal Pain Relief Promotion Act (PRPA) of 1999, she said.

[The PRPA, proposed in response to Oregon’s Death With Dignity law, would have created a narrow test for legal use of controlled substances and would have granted far-reaching investigative and punitive powers to the Drug Enforcement Administration (DEA).]

"This bill would have had a seriously negative effect on both patients with cancer and others suffering with pain. As an organization, we called on our members to contact their congressional representatives and senators by telephone. The response was so overwhelming that Hill staffers begged us to stop. We were shutting down the phone system. Now that is power!"

At the congress, ONS called for funding increases for the NIH, National Cancer Institute, and Centers for Disease Control, and members were given postcards calling for the budget increases to send to the President saying, "Will you stand with us, President Bush?"

ONS also issued a position paper outlining how the public and private sectors can address the nursing shortage and the medical needs of the nation’s growing elderly population.