Leading From Where You Are: The Nuanced Journey of Oncology Nursing Leadership

TON - May 2025 Vol 18, No 2
Jennifer Bires, MSW, LCSW, OSW-C
Inova Schar Cancer Institute,
Falls Church, VA

May is National Nurses Month—a time to celebrate the invaluable contributions nurses make across the healthcare continuum. It’s also a powerful reminder that nurses are not only caregivers; they are natural leaders.

Leadership in oncology nursing is not a destination marked by titles or organizational charts but a fluid journey of continuous transformation. It is a path that winds through hospital corridors, weaves between patient interactions, and emerges in moments both subtle and profound. Unlike traditional leadership models that prioritize hierarchy, oncology nursing leadership flows like water—finding unexpected paths, adapting to challenges, and ultimately reshaping the healthcare landscape.

Picture a typical day for an oncology nurse. She moves through her world not with an official badge of authority, but with a deep, almost instinctive understanding of patient needs that transcend formal roles. When a newly diagnosed patient looks lost and overwhelmed, she takes a moment to translate complex treatment protocols into compassionate, understandable language. When a colleague struggles with a challenging case, she offers insights drawn from years of hard-earned experience. These are not mere interactions; they are acts of leadership.

Informal leadership is the invisible infrastructure of healthcare—a network of support, knowledge, and compassion that doesn’t announce itself with a nameplate or an official mandate. It reveals itself through expertise, emotional intelligence, and an unwavering commitment to patient care. The informal leader in oncology nursing might be the resource who untangles complex medication regimens, identifies subtle workflow inefficiencies, or creates a supportive network for colleagues navigating the emotional intensity of cancer care.

What distinguishes oncology nurses is their extraordinary systems perspective. Unlike professionals confined to narrow specialties, they follow patients through entire journeys—from initial diagnosis through treatment, survivorship, or end-of-life care. This comprehensive view allows them to see interconnections that others might miss. They see the intricate dance between medical interventions, patient experiences, institutional policies, and human emotions. This system’s lens is a powerful leadership tool.

For nurses aspiring to leadership, the path is rarely linear. It begins with clinical excellence but extends far beyond. It requires curiosity about systemic challenges, courage to propose solutions, and the resilience to continue advocating even when progress seems slow. Leadership is built through consistent, small actions: mentoring a junior colleague, documenting a process improvement, affecting policy changes. Below are strategies for 3 areas of leadership growth and some first steps you can take.

Leading by Mentoring: Investing in Others

Mentorship is one of the most immediate and impactful ways to lead. When experienced nurses invest in those newer to the field, they foster confidence, competence, and continuity of care.

AONN+ supports mentorship through structured programs, including its BOLD mentorship program and ongoing professional development resources. These efforts help create a culture of learning, collaboration, and accountability. As mentor and mentee grow together, both strengthen their leadership ability.

Mentoring relationships don’t need to be formal to be effective. Offering to debrief after a difficult patient conversation, sharing resources, or simply listening can build trust and show leadership in action. Effective mentors are generous with their time, authentic in their guidance, and persistent in their support, especially when mentees face setbacks or uncertainty. More formalized mentorship can also be helpful and comes with its own set of guidelines.

Steps to Becoming an Effective Mentor

  1. Assess your readiness and motivations: Reflect on your experience level, communication skills, and willingness to commit time to mentoring relationships.
  2. Set clear expectations: Define meeting frequency, communication methods, and goals with your mentee if mentoring in a more formalized manner.
  3. Develop a Holistic Approach to Support: New oncology nurses need guidance on technical skills, self-care strategies, coping mechanisms for the emotional challenges of the work, professional networking, and career development.
  4. Commit to Ongoing Evaluation and Growth: Assess progress toward establish goals and solicit feedback from your mentee on how things are going. Celebrate success!
“Mentorship is a powerful act of leadership that builds the future of oncology navigation one relationship at a time.”
—AONN+ Mentorship Work Group

Leading Quality Improvement: Solving Problems With Data and Heart

Great leaders are solution focused. They see problems not as roadblocks but as opportunities to improve care. Oncology nurse navigators are especially well-positioned to lead quality improvement (QI) efforts because they are both frontline observers and trusted patient advocates. They notice the patterns others might miss—like patients slipping through follow-up cracks or delays in pain management—and they care enough to do something about it.

Effective QI work requires both data and storytelling. Data show us the scope of a problem and help track improvement over time. But it’s the patient stories that bring urgency and meaning to those data—making it resonate with colleagues, administrators, and decision-makers. For example, finding that 35% of patients are not receiving distress screening is powerful, but pairing that with a patient story about missed emotional needs brings the data to life and sparks deeper engagement.

AONN+ supports this dual approach through its Standardized Evidence-Based Oncology Navigation Metrics, which provide a framework for tracking performance and demonstrating impact. These metrics help nurses and navigators not only show areas for improvement but also communicate the value of their work in ways that inspire change.

Whether it is reducing avoidable emergency department visits, improving care coordination, or closing gaps in survivorship care, nurses can use a simple QI model like Plan-Do-Study-Act (PDSA) to test and scale solutions. Start small. Measure impact. Share stories.

Developing a Quality Improvement Project

  1. Gather baseline data: Document the current state using measurable metrics.
  2. Apply improvement frameworks: Use proven methodologies like PDSA or Lean.
  3. Engage stakeholders: Include patients, physicians, pharmacists, and administrators for comprehensive input.
  4. Implement small tests of change: Start with pilot projects before full-scale implementation.
  5. Measure and communicate results: Share outcomes widely to build support for sustained change.

Leading Through Advocacy: Using Your Voice for Impact

Oncology nurse navigators are powerful advocates. Their proximity to patients gives them deep insight into the challenges people face across the cancer continuum—from delays in diagnosis to barriers in survivorship care. Leadership in advocacy means using that insight to push for change in systems, policies, and funding priorities.

If learning more about how to change policy is a leadership area you want to lean into, AONN+ actively supports advocacy through its Policy and Advocacy Committee, which offers tools and guidance for nurses and navigators seeking to influence healthcare policy. Advocacy can take many forms: meeting with legislators, testifying at hearings, sending public comments, or educating peers about pending legislation.

What unites all these efforts is persistence. Policy changes rarely happen overnight, but persistent leaders understand that every letter, every story, and every visit matters. Advocacy is not separate from patient care—it is patient care on a broader scale.

“As nurses and navigators, our expertise doesn’t end at the bedside. It belongs in the boardroom, the legislature, and every room where healthcare decisions are made.”
—AONN+ Policy and Advocacy Committee

Practical Advocacy Opportunities

  • Institutional level: Join or create a nursing practice council.
  • Professional level: Participate in AONN+ or other nursing policy committees.
  • Community level: Organize patient education events or support groups.
  • State/National level: Attend policy summits or legislative days organized by nursing organizations.

The healthcare landscape is continuously evolving, and oncology nursing stands at a critical intersection of medical technology, patient experience, and human compassion. Leadership in this context is not about maintaining the status quo, but about continuous adaptation and improvement. It’s about seeing beyond immediate tasks to the broader vision of patient-centered care.

Ultimately, leadership in oncology nursing is an act of hope. It’s a commitment to improving not just individual patient outcomes, but the entire system of care. Whether through a formal title or an informal moment of connection, these nurses are the quiet architects of healing, transformation, and human dignity.

You don’t need a title to lead. You just need the courage to start.

Sources

Academy of Oncology Nurse & Patient Navigators. Mentorship Resources. https://aonnonline.org/professional-development/mentorship

Academy of Oncology Nurse & Patient Navigators. Navigation Metrics. www.aonnonline.org/navigation-metrics

Academy of Oncology Nurse & Patient Navigators. Policy & Advocacy. https://aonnonline.org/policy-and-advocacy

Farag AA, Taha EE, Abdel Aziz HA. Effect of quality improvement education on nurses’ performance and patient outcomes in oncology care. Journal of Nursing Education and Practice. 2020;10(4) 44-53.

Sherman RO, Pross E. Growing future nurse leaders to build and sustain healthy work environments at the unit level. Online Journal of Issues in Nursing. https://doi.org/10.3912/OJIN.Vol15No01Man01

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