Interview Series: Carlton Brown, PhD, RN ONS President

Carlton Brown, PhD, RN, has been a member of ONS for 18 years and is in the second year of his 2-year term as president. He is also an assistant professor in the University of Delaware’s School of Nursing.

Brown formerly served in the US Army, most recently as a clinical nurse educator at Walter Reed Army Medical Center (WRAMC) in Washington, DC. He also worked as a clinical head nurse and clinical nurse specialist at WRAMC.

His most recent research includes “The Effect of an Oral Care Protocol on Oral Mucositis in Patients With Head and Neck Cancer Treated With Radiotherapy” and “The Lived Experience of Oral Mucositis in Head and Neck Cancer Patients Treated With Radiation.”

At the ONS 36th Annual Congress, Brown spoke with OncLive Nursing about a variety of topics concerning the current and future state of oncology nursing.

OncLive Nursing: How will healthcare reform affect oncology nurses?

Brown: We know that there are probably 30 to 35 million Americans who right now are uninsured, and in 2014, when every person will have healthcare insurance, that’s obviously going to create a burden on nursing, on all of the healthcare providers. And so…it’s really frustrating when people say that we’re not really having a nursing shortage right now, because it’s kind of in disguise because of the economy, but healthcare reform is going to add more patients to the workload system.

The good news is that there is a lot within healthcare reform to encourage nurses to get a more advanced degree, so maybe to go to become a nurse practitioner or clinical nurse specialist. There are loans for that. There are repayment plans for people who already have an education…There’s going to be scholarships. I think for any individual, now is a great opportunity to either become a nurse because of healthcare reform and the opportunities written into the law, but also it will be important for those who are currently practicing nursing to become more advanced in their practice.

Will you discuss oncology nurses’ use of social media applications?

Social media is something that I’m very proud that oncology nurses [are] doing. Of course, we have Facebook, Twitter, and LinkedIn, and we have done a really good job with [those]. I think it’s a good way to connect all nurses together, but in particular…those nurses that may be in less populated areas…I was asked at [the] opening ceremony yesterday to do a tweet that would connect all of the nurses who were following ONS, pulling them all in.

[Also] the [ONS] Board just recently decided to add [technology as] a new pillar to our strategic plan…because I think that we really need to be thinking about what are the new things beyond social media. What are we going to be needing in 5 years and 10 years from now, trying to stay very pertinent to our members, and social media has been a good example of a way to reach out to our members.

We started to discuss this topic earlier, but let’s explore it a little further. Is there a shortage in oncology nursing, and, if so, what strategies is ONS employing to address the issue?

Well, I’d say that right now…the shortage not only in oncology nursing, but also in nursing [overall], is kind of in disguise. The economy has been very diffi cult, and so, in the past you may have had 3 or 4 wards or units that stayed at 50 or 60 percent capacity of patients, and you had nurses working on all of those. And I think that there are some hospitals that have closed a couple of wards and went to 100 percent capacity, and have kind of put those nurses out of jobs. And so I know that on both the east coast and the west coast, there are nurses who are having diffi culty finding jobs. However, in the middle of the country…there’re plenty of jobs for nurses. So the way it looks right now, it looks like we are in disguise of the nursing shortage.

However, once the economy recovers, many of these nurses who may have wanted to retire in the last 5 years are going to retire. So we are going to be in a shortage of nursing, and, as I’ve already mentioned, we have 30-plus million more Americans that are going to be needing healthcare, and I think that we’re going to be in a world of hurt in 10 years. The problem, one of the major problems, because I’m a faculty member at a school of nursing, is that we have a faculty shortage. I mean we’re turning—when I say we, [I mean] here in the United States—we are turning nursing students away every year because we don’t have enough faculty to teach those students, and that’s because the pay for a faculty member is very sad. It’s very low. So I’ve been a nurse for 20 years and have a PhD in nursing. Any nurse who graduates can go to work in an emergency room on a nightshift and make more in her fi rst 6 months as a nurse than I’m making as a faculty member. And that’s kind of how it is with society anyway. We don’t pay teachers well…If you think about a high school teacher, it’s not something that you’re going to get rich at.

So, yes, we have a nursing shortage. It’s going to get worse, and it’s going to be quite a problem, and [addressing the] faculty shortage is one of the solutions.

[The Oncology Nursing Society is] working with schools of nursing to try to help attract nursing students to oncology nursing. We’re trying to fi nd ways to attract nurses that might be practicing in other areas to oncology nursing. It is on our mind. We are working with the American Nursing Association, as far as faculty issues are concerned. So it is in our foresight and we are working on it, but I think it’s going to be quite a problem. Probably 5 or 10 years from now, we’re really going to feel the effect of the nursing shortage.

Carlton Brown, PhD, RN, addresses attendees at the ONS 36th Annual Congress.

Beyond attracting faculty, are there other issues with oncology nursing education that need to be addressed?

Lately we’ve been talking about [the fact that] there are 3 million nurses in the United States, and many of them don’t consider themselves oncology nurses, per se, but we know that many of them on a daily basis come into contact with an oncology patient— maybe in a home health arena, maybe in hospice palliative care, maybe in some kind of technology center [with a] mammogram. And so at the Oncology Nursing Society, we’ve been thinking about how can we better prepare those nurses who do not consider themselves oncology nurses? How do we get the content out to those nurses, so that they continue to provide quality cancer care to patients? And so if anything, that’s really the area where we will be doing work in the next 5 years, creating a portal online where information about oncology nursing is positioned, so that [a nurse] doesn’t necessarily need to be a member of ONS to get this access. It’s going to be free access. So that’s one of the areas that we’re working on.

Please discuss the textbook you edited, A Guide to Oncology Symptom Management, and its focus on evidence-based practice?

Thank you for mentioning my…textbook. It covers 20 symptoms, such as hair loss, nausea, constipation, and depression, and it is [written] from an evidencebased practice approach. In other words, we have sifted through all of the research to say, “What is the best way to treat a particular symptom?”

And so…my textbook…presents all of the options out there, and then works through the evidence to say, “What is the best evidence practice for each of those symptoms?”

There’s a second textbook [A Patient’s Guide to Cancer Symptom Management] out now that just came out 2 months ago, and we took [the fi rst] textbook and…wrote [another] textbook…at the fi fthand sixth-grade level for patients. So now a patient can sit down and read it and say [for example] “I have nausea. Let me read up on what that means.”

Oral oncolytics and genetic testing will be major factors in oncology going forward. What is ONS doing to prepare oncology nurses for this future?

Oral medications [are] a big area. [Treatment is now] very focused…In the old days, let’s say you had a lung cancer. There was a standard group of chemotherapies that every lung cancer patient… received. And now we’ve been able to genetically look at that cancer and say, “What’s specifi c about it?” and then give some of these oral chemotherapy agents. Genetic testing is another big area. Now that the human genome has been mapped, we will eventually be able to look at genes and say, “You’re at risk for pancreatic cancer,” long before you’re diagnosed.

So we talk a lot about adherence [to] oral medication, because [maybe] you’re somebody that’s never had to take a medication in your life, and now you’ve got to take this medication 4 times a day at a particular time. So we’re looking at ways…to help patients to remember to take it…We are doing research around adherence.

And then we have our own genetics program. ONS has published a couple of genetics textbooks. Genetics really [will] be the wave of the future, as I said, because of the [mapping of the] human genome…We can even now see who is [at a] higher risk for nausea. We can see who…is [at a] higher risk for hair loss. So we have not even begun to tap cancer care from the genome approach.

[And going back to] healthcare reform. In the old days you [had] to be worried about genetic testing. Let’s say that you do genetic testing and you’re at risk for colon cancer, and that information falls into the hands of the…insurance company, and they just say, “Okay, here’s somebody that’s at risk for colon cancer. Let’s cancel their insurance because that way we don’t have to pay for their care.” And that’s always been the big fear. Well, as of 2014, [with] healthcare reform, it’s illegal to cancel a person’s insurance either by a preexisting condition, if you’ve had cancer before, or if you’re diagnosed with cancer in the future. So that will open it up so that people will be more likely to have genetic testing, and then allow it to be used for their future care, almost like a preventative focus.

"It takes the right person to do it, but [being an oncology nurse] is a great job, and I think there are going to be incredible economic opportunities."

What would you say to an undergraduate nurse to convince him or her to become an oncology nurse?

People think that oncology nursing is sad, but to me, it’s a great job. I think that a nurse is meant to work in a particular area. For instance, I’m not a pediatrics person. I can’t work with children. I just would want to sit down and cry with them, if they’re in pain or something like that. It takes the right person to do it, but [being an oncology nurse] is a great job, and I think there are going to be incredible economic opportunities.

You know, the one thing I’ve not mentioned is there’s also a shortage of medical oncologists, and so that’s going to [create openings] for more advanced practice nurses literally taking care of more and more patients.

So it’s not a sad job, but everybody can’t do it. Patients are experiencing…one of the worst times in their life, and it’s an honor to be there and to help and improve that, and for many of those patients, it means cancer survival. You know, we’ve got 12 million cancer survivors right now. Cancer is no longer…a death sentence…

So I…encourage nursing students to go and work on an oncology ward for a couple of weeks to see if [they] like it. Maybe it isn’t for [them], but, as you can see, with [ONS having] 37,000 members, there [are] a lot of nurses that actually do like it, and it’s a great job.

Recently there have been several retrospectives on the War on Cancer. Are we winning the War?

I guess that depends on what day you ask me and what patient I’m taking care of at the time. We certainly are winning the War on Cancer…[There are] 12 million cancer survivors. We are really making inroads; the incidences of cancers are down. Are we where we want to be? I mean we can’t really rest until no other patient is diagnosed with cancer. Will that happen in my lifetime? I’m not sure, but as long as we are having people who are smoking, people who are not doing proper preventative situations, we are going to continue to see cancer.

But, there are several cancers that we have really stopped…[the] number of incidences, so I think that we’re winning. Some days it feels like we’re not winning, that we take a step back, but I think it’s one of those [things where we] take 2 steps forward and [then] take a step back…If you’re diagnosed with cancer now, as opposed to 20 years ago, your opportunities for long-term survival are so much better. And…the other question [is] how do you defi ne winning? [For example] is it quality of life for patients? So I think that we’re winning, [but] we still have a lot of work to do.

What take-home message(s) do you have for nursing attending the ONS Congress?

Get active in your local legislation. We have new laws for healthcare reform that will protect patients with cancer, and it’s going to be the nurse’s responsibility to educate them about what those new changes are. I would tell them to get involved with legislation, understand these new laws, and get that information out to patients, so patients can understand that an insurance company does not have a right to cancel [their] insurance because [they’re] diagnosed with cancer. So…get involved, learn about healthcare reform legislation, and start sharing that [information] with patients.