Examining a System in Distress: The Present and Future of Oncology Nursing

The largest strike of private-sector nurses in the United States occurred in September 2022, when approximately 15,000 nurses across 16 Minnesota hospitals launched a three-day protest due to the staffing challenges plaguing the state’s healthcare system. Earlier this year, more than 7,000 nurses at Montefiore Medical Center and Mount Sinai Hospital in New York City, launched another three-day strike—citing workforce issues as the primary reason. “There was moral distress. The nurses that had to walk away from that baby at 6:00 AM, the nurses that knew that patients were going to come in for chemotherapy that day and they were not going to be there to see them—there was so much distress,” said Una Hopkins, DNP, RN, FNP-BC, director of research at Montefiore Einstein Center Cancer Care, as she discussed this nursing strike at the ACCC 49th Annual Meeting & Cancer Center Business Summit (#AMCCBS) earlier this year. “It is upsetting because I am nurse.”

Mark Liu, MHA, senior director of oncology strategy, transformation, and analytics, Oncology Service Line at Mount Sinai Health System & Tisch Cancer Institute, echoed Hopkins’s sentiment on the issue. “We aim for perfection, but, in moments of crisis, there is a lot to handle,” he said. According to Liu and Hopkins, burnout, stress, and a reduced workforce contributed to the NYC nursing strike. “It wasn’t about salary. It was about fighting for safer staffing ratios and not wanting to take care of patients in hallways,” Hopkins explained.

Nursing strikes across the US are becoming dangerously frequent, and this is particularly concerning as nurses are the nation’s largest healthcare providers. They are also the most trusted according to the 2022 Gallup Honesty and Ethics poll. Nurses have topped the Gallup list in all but 1 year since they were added in 1999. The outlier is 2001, when firefighters were measured on a one-time basis shortly after the September 11 attacks. However, many nurses are now reconsidering their future in the field.

A System in Distress

In a 2022 McKinsey & Company survey, 29% of registered nurses in the US indicated they were likely to leave direct patient care. Considering that overall patient demand is expected to rise as the population continues to grow and age, should even half of these nurses follow through on that intent, it will exacerbate the issues of an already unbalanced supply and demand chain within the US healthcare system. It is estimated that by 2025, the US may have a gap of between 250,000 to 450,000 nurses available to deliver direct patient care. By 2026, more than 3 million nursing positions in the US are expected to be open.

A crisis is on the horizon, and the administrative staff at healthcare institutions are rightfully concerned. In a 2019 survey conducted by the Foundation of the American College of Healthcare Executives, 81% of the community hospital CEO’s sampled included the shortage of registered nurses as one of their top 3 staffing concerns. Although much has been made of the effects the COVID-19 pandemic has had on the current nursing landscape, this finding suggests it only exacerbated already existent problems. This is further demonstrated by a 2019 study from the University of Pennsylvania, which measured burnout among 33,462 registered nurses and found 40% of them experienced high levels of burnout.  

The Oncology Workforce

Recognizing the magnitude of this issue and the impact it will have on the oncology workforce, ACCC President Olalekan Ajayi, PharmD, MBA, chief operating officer for Highlands Oncology Group, PA, centered his 2023-2024 ACCC President’s theme on (Re)Building the Oncology Workforce to Deliver Next Generation Cancer Care. Dr Ajayi believes that establishing structures and resources to support various members of the multidisciplinary cancer care team will be key in achieving this goal. “We need to provide the resources for our workforce, so they know where to get the information they need to provide the services patients need,” Dr Ajayi said while addressing the President’s Cancer Panel during their first National Cancer Plan Stakeholder meeting earlier this month.” “We also need to identify new professions within the cancer care spectrum that will facilitate this goal.”

In an upcoming ACCCBuzz blog post, major takeaways from the President’s Cancer Panel - National Cancer Plan Stakeholder meeting will be discussed. Stay tuned.