Nurses who provide care to cancer patients do some of the most emotionally difficult work there is in medicine. The life and death situations they routinely face can lead to what was once known as burnout, but is now called "compassion fatigue." The issue is compounded by the ethical dilemmas that frequently surround end-of-life treatment decisions made by physicians and family members.
This week on “Take Care,” Pattie Jakel discusses the ethics of oncology nursing. Jakel is a clinical nurse specialist in the Solid Oncology Program at the UCLA Santa Monica Hospital, Santa Monica, California. She has a master’s degree in nursing and has published studies on the ethical conflicts of oncology nursing.
Jackel says that oncology nurses can be found in many different healthcare locations.
“They can work anywhere from a hospital, to a clinic, to palliative care, to hospice, to radiation therapy and it’s really someone that has to have a passion and have a passion for oncology nursing,” Jakel says.
Jakel says that the kinds of recent college graduates who want to pursue oncology nursing aren’t just those who had a personal incentive in a loved one with cancer. A lot of the job candidates she finds say they just have a strong passion for oncology.
“They’re good communicators,” Jakel says. “In the interview, they listen more than they talk. And that’s good that these people have the ability to listen because a lot of what we do is listen to people.”
According to Jakel, oncology nurses are constantly put in ethically difficult situations. Perhaps the biggest question they can ask themselves is whether or not care might be futile.
While Jakel says that giving someone care is never wasted, but she fears that futile treatment can bring nurses and physicians alike to a point where they’re dissatisfied with their professional lives. This may lead to a breakdown in communication with patients and their families, and might place important decisions in the hands of patients that doctors would be more suited to make.
“We give a lot of autonomy to our patients to make decisions in our healthcare system in the United States so we believe patients have rights and I absolutely agree with it. But there’s a time when a patient really said to me, ‘how do I know how to make this decision? I’m not the doctor. I don’t know what I should do about this.’ So I think it puts a lot of stress also on the patient, the people on the other side of the bed,” Jakel says.
That becomes what Jakel calls a “dance back and forth with the family members” but stresses that it’s important that nurses speak up when they don’t agree with a decision regarding the conditions of their patients.
Instead of staying “silent while watching,” Jakel says oncology nurses should be a part of that patient’s time in care because they spend a lot of time with them and know them well.
“We take care of them in this unit, in particular from the time of diagnosis and often to the time of death,” Jakel says. “You’re with them at some of their most intimate moments. Nurses are exposed to that and they really have that strength. If they really have a strong relationship with their patient, I’ve seen nurses be very forthright and very strong in their convictions for the patient.”
