St. Luke’s Cancer Institute, Boise, ID, is celebrating its 50th anniversary this year. Formerly known as Mountain States Tumor Institute, St. Luke’s employs medical and radiation oncology specialists, as well as fellowship-trained cancer surgeons in areas such as thoracic, hepatobiliary, gynecologic, and urologic oncology. The facility also offers autologous and allogeneic bone marrow and stem-cell transplantation and is a National Marrow Donor Program Apheresis Center. In addition, St. Luke’s is home to Idaho’s only pediatric cancer program and federally sponsored hemophilia center.
The main goal of care at St. Luke’s Cancer Institute is to support patients and their families along the cancer journey trajectory—treating the disease; easing symptoms and side effects; and providing physical, mental, and emotional support. The Oncology Nurse-APN/PA (TON) spoke with Dia Byrne, MSN, RN, ACNS-BC, OCN, about her role as a Clinical Nurse Specialist (CNS) at the center.
Ms Byrne: I have been a nurse at St. Luke’s for almost 21 years and have been in my current role as a CNS for approximately 10 years. As a CNS, I support our oncology service line, predominantly outpatient oncology. We have 12 CNS’s within the Nursing and Patient Care Center of Excellence who support quality care throughout our system.
My job is to support clinical practice through content, expertise, policy and protocol development, evidence-based practice (design and innovation), and practice consultation for other nurses. I support nurses in their role of caring for patients with cancer. When nurses have a question regarding a practice or current technique, I am there to support them and further the inquiry.
Our cancer institute has 5 full-service outpatient centers and 3 limited-service facilities. Because of the geographic area we cover, sometimes I travel 2 hours each way to visit our sites and offer support.
Ms Byrne: Supporting a wide geographic area is challenging. However, my greatest challenge would likely be keeping up with the pace of changes in oncology (eg, drug development, immunotherapies, and advances in nursing care). It can be challenging to facilitate cutting-edge nursing practices and translate current research when the landscape of oncology is advancing so quickly.
Ms Byrne: After 20 years, the most rewarding part of my job is knowing that I am helping patients with cancer. My aim is to influence not only their clinical outcomes, but also their overall care experience.
I receive a great deal of satisfaction from working in multidisciplinary teams and program development. We have a rich history of collaboration at St. Luke’s Cancer Institute. It is professionally rewarding to consistently work with a team that includes physicians, nursing, pharmacy, and leadership personnel. Translating the team approach to the care of the whole patient is the cornerstone of supportive oncology, and, at our center, that includes social work, nutrition, financial advocacy, survivorship, palliative care, rehabilitation, integrative medicine, spiritual care, and psychiatry. A key component of our approach is collaboration and shared governance. Much of this is borne out of Magnet principles. This spring, St. Luke’s (Boise) is expecting its 5th Magnet site visit from the American Nurses Credentialing Center.
Ms Byrne: When I graduated from nursing school, my first job was at St. Luke’s. At the time, I was not drawn to work in oncology, and I did not know much about the field, but that is the department that hired me. However, after 3 months, I knew that I had found my “home.” Approximately 10 years later, I decided to pursue an advanced degree. I considered the options and decided that my desire for nursing advocacy and my particular skill set were a good fit for becoming a CNS.
I had the opportunity to participate in a unique program. I pursued my master’s degree and Advanced Practice Certification while working within a professional development residency. This provided me the opportunity to gain experience in the CNS role under a mentor at the cancer center while getting my advanced degree.
With that on-the-job training, I was far more prepared to hit the ground running than if I had pursued my degree under a different model.
Ms Byrne: I am excited about some of the new models of care (eg, oncology urgent care and enhanced care coordination). Reducing unplanned emergency department visits and hospital admissions for patients with cancer is a focus nationwide. The Centers for Medicare & Medicaid Services is making this a priority by identifying a chemotherapy-specific quality measure around reducing preventable emergency department visits and admissions.
We are currently identifying strategies for this work. Enhanced care coordination for patients on active treatment may also have an impact on outcomes. This includes timely symptom management education and appropriate referrals. Simply telling patients about services that are available may not be enough. Helping to navigate them to the appropriate supportive services requires a proactive approach.
Care coordination takes into consideration key principles, such as risk stratification. Nurses are highly trained to identify patients at risk for poorer outcomes, to intervene appropriately, and to navigate these patients to helpful services.
Ms Byrne: I did at first, but the satisfaction I feel in my current position has eclipsed that. I am passionate about collaboration, using a team approach, and putting evidence into practice.
Ms Byrne: I would say “yes.” This role is challenging because oncology care is changing rapidly. If I won the lottery, I would probably take a few more vacations. Also, the money would likely help me to complete my doctorate degree.
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