Most cancer care happens in community settings—and oncology nurses are at the center of it. Ryne Wilson, DNP, RN, OCN, CNE, President of the Oncology Nursing Society, joins us to discuss how nurses are managing complex symptoms, navigating patient barriers, and using new clinical tools to deliver smarter, more coordinated care—plus what’s next for the profession.
Kristin: Hi, it’s Kristin Siyahian here with the Cancer Clearly podcast, and I’m so excited to welcome my next guest to the podcast booth. I’m here with Ryne Wilson. Ryne is a clinical assistant professor at the University of Minnesota School of Nursing and also the very recently appointed president of ONS.
Welcome.
Ryne: Thanks so much for having me. I’m very happy to be here.
Kristin: It’s great to have you. Oncology nursing is a subject near and dear to my heart for many reasons, having been affected by cancer through family members, but also from being the editorial director on JONS for so many years and The Oncology Nurse.
It’s a very important topic. First, congratulations on becoming president of ONS. That’s super exciting. I’d love to know your vision of the role of oncology nursing. It’s becoming more and more complex with the advent of new treatments and with patients being treated outside of academic centers. How do you see that role evolving?
Ryne: It’s a great question. Again, thanks for having me, and thanks for showcasing oncology nursing here at ASCO. It’s always a privilege, and I’m certainly grateful to be stepping in as president of ONS.
I think about this in two different sides of the equation. One side is that there is certainly a need for us to evolve the science to better understand what the needs of the oncology nurse are in today’s world, both in academic centers and in community practice. There is the science of understanding the pharmacology, the complex nature of treatment delivery, and how to manage people who are receiving these therapies.
Those innovations are changing the way oncology nurses deliver care. They change where we deliver care, how we deliver care, and the types of things we think about as someone goes through cancer treatment. What we thought about 20 or 30 years ago is very different today in terms of the side effects we look out for and the way we manage those side effects and symptoms.
On the other side, there is this human component to nursing that will remain everlasting. There are elements of our profession that will remain the same: compassion, the art of nursing, meeting people where they are, and understanding that patients are whole human beings with many things happening in their lives beyond just a cancer diagnosis.
Oncology nurses are very well adapted at understanding that, recognizing it, and making sure that the holistic perspective of the patient, their family, and the people who love them remains an important part of care. That element of oncology nursing will endure forever, and it’s what makes me most proud of being an oncology nurse.
Kristin: Very well said. Oncology nurses are angels on earth, and burnout is a major issue because they give so deeply of themselves to their patients. I appreciate that answer very much.
Thinking about how ONS can best support its membership and oncology nurses everywhere, I know you have many resources available. A few I wanted to call out are the Symptom Management Resource Guide, the Biomarker Database, and the Huddle Cards. I was hoping you could briefly talk through each of those, what they are, and how they’re best used.
Ryne: I have to give a shout-out to our clinical team, the clinical staff at ONS, and the hundreds and hundreds of volunteers who contribute to these resources. They keep them innovative, evidence-based, and grounded in the highest quality of evidence to inform what we deliver to our members and to the profession as a whole.
You mentioned the Symptom Management Resource. I know this resource really well because I volunteered as part of the review for chemotherapy-induced diarrhea management. This resource covers a variety of symptoms and side effects from treatment.
The way it works is that we tier the level of evidence. We conduct a large literature review and literature search across a variety of topics and interventions that may be useful in addressing symptoms and side effects. We go through a standardized, rigorous process to identify the best available evidence. We look at how the studies were designed and evaluate the strength of the data.
The evidence is tiered into green, yellow, and red categories based on the level of evidence and the amount of information supporting it. It’s intended to be a just-in-time, point-of-care resource for oncology nurses who are incredibly busy and who don’t have time to read scientific papers at the nurse’s station.
We’ve done that work to synthesize the evidence so nurses can quickly see the best way to manage something like mucositis, for example, as well as the caveats they may need to consider depending on the type of treatment the patient is receiving. These resources are routinely updated and cover a variety of topics. The Symptom Management Resource is spectacular.
Kristin: You brought up something important: looking at what the treatment is. With the advent of bispecifics, trispecifics, cellular therapies, and immunotherapies, you really have to pay attention not just to what the side effect is, but to the treatment it came from.
Ryne: Without a doubt. That information seems to be changing daily. The way we manage these side effects is changing. Mucositis from chemotherapy, for example, might be very different from mucositis related to an antibody-drug conjugate or another treatment a patient is receiving today.
That’s why this resource is so important. Package inserts give us a lot of guidance and are definitely informative, but there is much more out there. This is a succinct resource that allows nurses to deliver the best care they can to patients.
Kristin: Invaluable. You also brought up the Biomarker Database.
Ryne: Yes, the Biomarker Database is a great resource and, in many ways, one of its kind. It sits within a broader pool of resources we call the Genomics and Precision Oncology Learning Library.
That library includes a wide range of materials, from introductory resources around genetics and genomics, including terminology and taxonomy, all the way to more advanced knowledge about types of biomarkers, how biomarkers inform prognosis and treatment, and how they support other parts of care delivery.
The Biomarker Database is a source of evidence. It helps explain what a biomarker is, what we understand about it, and what clinicians might consider in terms of how it could be used in clinical practice. I’m honored and grateful to have contributed to the Biomarker Database as well. My background in GI oncology came in handy there.
The Huddle Cards are another great resource. We have Huddle Cards for precision medicine and genomics, as well as for a variety of other topics. These are tools for nurses on the floor, in infusion suites, and out in community settings. They are designed as one-page documents that summarize key information, helping nurses huddle together and discuss what they need to understand about a topic, what the highlights are, and what the key takeaways should be.
They’re very point-of-care and very handy. All of these resources are available on ons.org.
Kristin: We just launched a new media platform called In Practice, specifically designed for those practicing in the community. Tell me about oncology nursing in a community setting outside of an academic center. How does that differ from an academic setting?
Ryne: Initially, we often think that community spaces can be more resource-constrained, and that is certainly true in many areas. The way care is delivered may also be a little different.
There is usually a very robust interdisciplinary approach, and it becomes especially important to make sure people are practicing at the top of their scope. That is something we care a lot about: making sure nurses are providing nursing care in the way they have been trained to do. It is even more vitally important in community settings that nurses practice at their full scope, from RNs all the way through APRNs.
The types of care nurses provide in community settings are the same, but in many cases they are doing more with less. That becomes increasingly challenging as treatments become more complicated and complex.
There are so many nuances now to the therapies people are receiving and the things nurses need to watch out for. Before, we had a broader understanding of chemotherapy and how to manage it. Mucositis associated with chemotherapy was thought of in a more consistent way. That is not the case anymore.
It can be really challenging for nurses in more resource-constrained environments.
Kristin: That’s a great point. It used to be more like, “If this, then that.” That’s not the case any longer.
Ryne: Right. I would also be remiss if I didn’t mention that we are facing a very significant nursing shortage. Many would say we are already in it. HRSA projections show a shortage of more than 200,000 nurses across the United States by 2038, and some areas will be hit more significantly than others, particularly rural and under-resourced communities.
We have to address two sides of that. First, we need healthy work environments to make sure the nurses currently in practice stay in practice, enjoy what they do, and can do it in a sustainable way. Second, we need to think about the pipeline.
The American Association of Colleges of Nursing recently released a report based on last year’s enrollment numbers. More than 90,000 qualified applicants were turned away from nursing programs across the country. That could have been 90,000 more nurses in the workforce.
We need to think about upstream approaches. As more care is delivered in the community, we have to make those roles more enticing. There have to be resources and funding to support nurses in these areas, from training and education all the way through to a career they can enjoy for decades.
Kristin: That reminds me of the expanding role of the oncology nurse. For years, I was editorial director on the Journal of Oncology Navigation & Survivorship, which focuses on nurse navigators, patient navigators, social workers, and others involved in the navigation process.
Do you find that a lot of nurses are also wearing that hat? Psychosocial support, community outreach, transportation, insurance issues, removing barriers to care, which is really the formal definition of navigation. Are nurses involved in that too?
Ryne: Absolutely. Nursing has been at the forefront of navigation, really understanding that there are many things outside the hospital that affect people’s health and care outcomes.
Nursing uses that lens, and navigation is a perfect example of that. Social drivers of health impact people’s ability to access care and the outcomes that come from that care. Someone may live just down the street from a major cancer hospital, but that doesn’t necessarily mean they will have great outcomes.
We have to be thoughtful about that, and I think nurse navigation is a great example of how to do that well.
Kristin: Do you think ONS members identify as navigators as well? Or are they nurses first, then navigators? Or is it all becoming one big pot now?
Ryne: There are certainly specific roles around nurse navigation. We have competencies, guidelines, books, and resources that inform that practice.
But I also think there is an element of every nurse’s practice that incorporates navigation. Nurses understand that there are more things affecting people’s outcomes than what happens in the infusion center or hospital.
As a nurse working in an inpatient hospital unit, I was navigating. I was figuring out transportation and rides for patients to get home. I was thinking about what to do when someone had 10 steps to get up to their apartment and was having trouble walking. I was helping connect patients with resources for healthy food and food access, including services like Meals on Wheels.
That work is certainly done collaboratively with social workers and other patient navigators in the community, who are critical to it as well. There is a specific role of nurse navigator, and it is critical. I was a nurse navigator myself for a little while. But there is also an element of navigation embedded across all nursing roles.
Kristin: Going back to symptom management, in the dawn of all these new therapies and side effect profiles, what challenges are you seeing for your membership, and how do you keep members up to date?
Ryne: There are many challenges, and we’ve already mentioned several of them. We talked about access to care and social drivers of health, and those certainly apply here.
One of the things I’m noticing is access to reliable, high-quality information about what nurses and patients should do. With the internet, social media, artificial intelligence, and all these new ways of accessing information, patients have so much available to them. Sometimes it can be difficult to parse through what is good advice and what may not be great advice, or how to understand that advice in the context of what a patient personally has going on.
Nurses, nurse navigators, and all nurses across the trajectory of care are great sources for patients to turn to when trying to understand what is legitimate and what may not be the right advice to follow.
I am sometimes disappointed by the misinformation that is out there. But nursing has been the most trusted profession for decades, and nurses are a great source of truth.
Kristin: Let’s talk about precision medicine, biomarkers, and immunotherapy. What kind of training and support is out there? What does ONS provide, and what are you hearing?
Ryne: Our clinical staff team at ONS participates in a lot of clinical immersions. We try to get ONS into the spaces where care is being delivered so we can understand what is happening on the ground.
Our priorities and the resources we develop are shaped by what nurses are actually doing and what they are experiencing day to day. We try to be intentional about ensuring broad representation, including where people are located geographically and the types of settings they work in, as we develop and create resources for nurses.
When it comes to volunteer calls, we make sure we have nurses represented from academic centers, but also from community centers. That way, they can bring perspectives such as, “That sounds great when you have those resources available, but what would that look like in a place like where I work, with the team I work with?”
Having that balance and broad representation helps us deliver the types of services, education, and resources nurses need from ONS to stay fully informed about what is happening on the ground.
Kristin: You’ve been president now for about two weeks. What’s the vision? What do you want to advance, and what priorities do you have for the coming year?
Ryne: There are many. We just launched our enterprise-wide strategic plan, which incorporates the Oncology Nursing Society, the Oncology Nursing Foundation, and the Oncology Certification Corporation. It’s a shared strategic plan from 2026 to 2028, and it includes a variety of strategies I’m very committed to as president.
One priority is looking at the career trajectory and career journey of the oncology nurse, from new graduate nurse through advanced practice and beyond. We are looking at the phases of that career trajectory and the different pathways within nursing, because there are so many. We want to understand what nurses need at those moments to achieve their goals from a professional development, education, and care delivery standpoint.
Over the next year, we’ll spend a lot of time and energy understanding career maps, career trajectories, and career journeys across the different roles within oncology nursing. I think that will help guide what the next era looks like.
We celebrated our 50th anniversary last year, and this is our 51st year as a society. So we are asking: what does the next 50 years look like for oncology nurses, and what will they need?
Another major priority for me is understanding the unique needs of nurses in relation to healthy work environments. Myself, our board of directors, and staff support from ONS are being intentional about understanding the dynamics within healthcare settings that contribute to or detract from healthy work environments.
We need to do this because we are seeing more nurses leave the profession because of these issues. It is time for us to understand what oncology nurses need in these spaces. We may think we know, but we need to do the work to really understand it.
Over the next year and beyond, we will put a lot of resources into better understanding those dynamics and figuring out what institutions need to do to support oncology nurses, what oncology nurses need to do for one another, and what we as a professional organization can do to support nurses.
Something has to change, or we are going to be in a world of hurt as we keep moving forward.
Kristin: May is National Nurses Month and Oncology Nurses Month, which is always very exciting, especially when you work with nurses. Anecdotally, we hear a lot about burnout and the reasons behind it. Do you want to comment on that, and what you’re hearing from ONS members?
Ryne: More and more nurses are being asked to do more with less. They are increasingly resource-constrained, regardless of the setting where they work. People may have certain perceptions of what resources are available, but it is becoming more difficult to deliver care.
The therapies and treatments themselves are becoming more complicated and complex, and that is becoming increasingly demanding for nurses. Nurses are up for the task. We don’t shy away from a challenge, and we are always going to be there for our patients no matter what.
But we have to think about burnout as a consequence of asking nurses to do more with less.
We also talk a lot about technology and artificial intelligence, and the opportunities they may offer in making care more efficient or effective. I think there is promise in areas like documentation and point-of-care support tools for nursing.
But there is always going to be that human element I referenced earlier, and that will never go away. While technology may have promise, I sometimes worry that making care more efficient and effective will simply mean nurses are expected to do even more because these technologies exist.
As a collective community in oncology nursing and beyond, we need to be thoughtful about these technologies. They should be adjunctive and supportive of what nurses are doing, not a replacement for nurses. We also need to make sure they do not contribute further to burnout.
Kristin: I completely agree. I have to tell you, I know several ONS members, and everyone is very excited about your presidency. It sounds like you have some wonderful key priorities that you’ll push forward, and I can’t wait to see what you do.
I’ve been asking everyone who comes through the podcast booth today: what’s the buzzword? What are we hearing at ASCO that has your attention?
Ryne: I attended the opening session this morning and listened to the ASCO president’s presentation. We still have a lot of the conference to go, so who knows what words will emerge. But for me, the word that really resonated was access.
He talked a lot about every patient, every cancer, everywhere deserving access to high-quality cancer care, and I couldn’t agree more. Access is the big takeaway from this morning’s session and what I’m going to carry with me.
Kristin: Great word. I love it. Thank you for joining me.
Ryne: Thank you so much.
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