Keeping Oncology Nurses Starts With Better Orientation

Heather Wood, RN, OCN, had been an oncology nurse for a decade in late February 2020 when the pandemic’s effects reached her clinic near Seattle, Washington, not far from where some of the first deaths from COVID-19 in the United States were reported. Wood had just been named an interim supervisor. “I’d never been in a supervisory position before. So, it was interesting,” said Wood, whose career had brought her to Compass Oncology in 2014.

Her clinic wasn’t spared the stress and staffing upheaval that hit oncology nursing nationwide, and Wood quickly saw a need for better onboarding for new nurses. The experience inspired her to take part in a pilot program to create a better orientation experience, which would increase both the new nurses’ oncology knowledge and their comfort level. It worked so well that in January 2023, Wood became a clinical education specialist, charged with extending the program across The US Oncology Network. She spoke with Evidence-Based Oncology (EBO) about her efforts to prevent burnout among new nurses.
This interview has been condensed and edited for clarity.

EBO: Tell us about your journey from being a brand-new supervisor during the pandemic to accepting the job you have today.

Wood: I became an interim supervisor the week before everything shut down. While I was in that role, I saw the huge need for nursing orientation, because I had a lot of new nurses on my staff. They were not quite a year in, and they were burning out because they felt like they didn’t receive that foundational education. They just felt like they were floundering.

Before my [current] position was created, there was a pilot program that surveyed all the new nurse hires that had joined the network in the previous year. The survey showed there was this huge need—the new nurses were unsatisfied with their orientation process; they felt like they weren’t well-equipped for their jobs. The nurse leaders were being pulled to be preceptors instead of being able to do their jobs as nurse managers and things like that. And so, [leadership] decided to do a network-led orientation program to supplement the in-clinic orientation for these nurses. The initial pilot program was successful, and the network created my position to run that program.

EBO: What kinds of challenges is this orientation program designed to address?

Wood: [At the time of the survey], around a quarter of the nurses in the network had been hired within the last year, and most had come to the network with little or no oncology experience. Oncology nursing is definitely a specialty; you don’t learn this in nursing school, and it’s a lot to learn. Typically, we would tell new hires that it will take you a year to feel comfortable. And that means trying to learn the fundamental oncology content while you’re also learning your day-to-day job.

Now, we feel like when we pull those nurses out, and they attend this orientation program, they get dedicated time to learn about cancer care—they learn what it really is. This gives new nurses an edge; they get to understand the concepts quickly compared with having to learn just through their day-to-day job.

EBO: What kind of feedback have you received?

Wood: The feedback has been very good. We’ve had over 100 participants from 25 practices, which is a large percentage of our oncology practices. The nurses do a pre- and post-course self-assessment, and the increase in knowledge is definitely noticeable. We use a color grid; we can see it switch from red and orange—where the nurses don’t feel they have much knowledge—over to blue, where they feel, “I’ve got this.”

EBO: How is the program structured?

Wood: There are not many programs like ours. We are a live virtual program; for the first year, the nurses attended once a week for 9 weeks, for a total of 22.5 hours. We bring in subject matter experts to discuss 13 core oncology concepts. We make it a bit interactive, and we add gamification. The structure will change next year—the nurses are going to come twice a week for 4.5 weeks; that’s based on leadership feedback. Also, we are considering bringing the nurses back for alumni sessions about 6 months down the road.

Not every practice participates in the program, but some practices are making it mandatory for all their new nurses because they have seen such a benefit.

EBO: Beyond gaining knowledge, when the nurses feel they know more, how does that affect their confidence? Do they feel less overwhelmed?

Wood: Yes. We had a panel [at The US Oncology Payer Transformation Summit] and the nursing leaders said not only did they see that the nurses were more confident in talking to their patients, but they were more confident in talking with their peers. One nurse leader mentioned, there’s this thing in nursing that “Nurses eat their prey.” But this orientation program builds relationships between the senior nurses and the new nurses to bridge that gap. So, we even see improvements in team functionality, which I think is a hidden benefit of the program.