Finding Your Why: Reflecting on the Passion Behind Oncology Nursing With Lauren Ghazal, PhD, FNP-BC

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I have the pleasure of being joined by one of our Editorial Board members, Dr. Lauren Ghazal. Thanks so much for coming on today.

Lauren Ghazal, PhD, FNP-BC: Thanks for having me.

Oncology Data Advisor: To start off, would you like to share a little bit of an intro about yourself?

Dr. Ghazal: Oh, yes. Hello everyone, my name is Lauren Ghazal. I am currently an Assistant Professor at the University of Rochester and a Family Nurse Practitioner. I'm just thrilled to be here and talk about a recent presentation that I gave.

Oncology Data Advisor: Yes, you gave the keynote presentation at ONS Bridge this week. Would you like to share an overview of what you talked about in the presentation?

Dr. Ghazal: I was really honored to be invited, and it was my first professional keynote, so that was an experience in itself. But I felt very comfortable, and there's a little less pressure with doing it virtually, but you miss that interaction with attendees too. I had the honor of presenting the keynote at this year's Oncology Nursing Society Bridge this past Tuesday, September 12th. I was invited to present following my involvement in ONS Congress's Mara Mogensen Flaherty Memorial Lectureship, more affectionately termed the Mara. After that presentation, it was reflected back to me that my Mara presentation really left attendees debriefing and reflecting on their own practices and themselves. I had this portion there of questioning your "why" and answering questions in a reflective process that could help you continue on in your careers and progress in whatever way is best for you in your oncology nursing career.

My keynote at Bridge had two main objectives. The first was to identify several factors contributing to nurse workforce sustainability, and the second was to provide participants with the opportunity to reflect their own desires and passions for pursuing a career in oncology nursing. To do this, I first shared some data, being a researcher, around the larger nurse workforce and central to oncology, and then discussed how this contributes to nursing sustainability. We all know that there are significant and substantial challenges to our workforce's sustainability. Our nation's over four million registered nurses work in every aspect of health care and are critical to delivering health care. We know that there are evolving health care systems locally and nationally, and we hope that with improving the sustainability of our nurse workforce, we can improve our nation's overall health.

I discussed challenges such as burnout and moral distress that have been well-talked about, though some would argue not talked about enough, which have stemmed from a demanding workload and staffing shortages and retention. I referenced one study in particular specific to oncology staff, a survey of over 200 cancer care centers by the US Advisory Board and the Association of Community Cancer Centers. It noted that among all their oncology staff, oncology nurses in particular had the highest rates of turnover, with about 10% to 20% of the centers reporting more than 25% turnover in the previous 12 months.

I also shared about the economics of the nurse workforce and the projected inadequate supply of our workforce resulting from rising openings coupled with an aging workforce. There are also prevalent challenges around nurses' personal safety that include risking exposure to infection, but then also assault and violence in the workplace. We've heard in the news recently a few personal stories of significant incidents of workplace violence against registered nurses.

Then I discussed opportunities within our workforce, and one takeaway that I got from my presentation in the Mara was that while we focused on challenges, we didn't really draw attention to anything positive about our workforce. We do have a lot of positives in our workforce. A few things that I shared were how we have a growing research base and research infrastructure and funds devoted to addressing burnout, nurse burnout, and opportunities to collaborate with our nursing colleagues across the globe, which I believe really strengthens a workforce.

There's an emergence of nurses being seen and heard as experts, and this increased visibility is a reflection of professional acknowledgement. Your invitation to me and the other nurses on the Oncology Data Advisor Editorial Board is recognizing our expertise as providers here, as advanced practice nurses and as registered nurses being seen and heard more in the media. It's important for me to draw in my own experiences where I was really fortunate to have a voice in that media by publishing some op-eds with CNN and then being asked to do an on-air interview last January with CNN. I think it's great for us to reflect on that, even early on in my career—to be asked not only what nursing does and what nursing is, but from your experience and your expertise as a nurse, what do you have to share with the public and what advice do you have? What recommendations do you have, but also what can we learn from your experiences?

Then I shared other opportunities. We have a growing body of research that has shown that telehealth and electronic health in undergraduate and graduate levels of education have allowed students to develop skills needed to embrace this utilization of telehealth and e-health. Lastly, I touched on another opportunity around advanced practice nurses with the laws and regulations that enable nurses to practice at the full extent of their education and licensure.

So, that was that first part. The second part was really more of a reflective experience. Even though I've responded to these questions that I posed to the audience, every time I do it, I take something else away from it. It's like a meta experience—I feel like I'm living it inside. The second portion of this keynote really dove a bit more into steps that the audience, oncology nurses in particular, could take to find their own "why" and their own voice in nursing. I applied Simon Sinek's Golden Circle as a model and then also asked some questions that I was shown and taught early on during my undergraduate years at Boston College from Father Michael Himes, who was a theologian.

First, I went through the Golden Circle model, which provides compelling evidence of how much more we can achieve if we start everything we do by first asking a simple question of "Why?". It's a model of concentric circles where the center circle is that "why" question. Then you start from that center circle and work your way out. You start with "why," which is the purpose. You'll get questions like, "What is your cause? What do you believe? Why are you an oncology nurse?" I posed that to the audience. Then taking a step to the next outer circle is the "how". That's all about the process. These are specific actions that folks can take to realize and get to the "why". Then the "what" is the result portion of "What do you do? What's the result of the why? What is the proof?"

I reflected a bit more on how we as oncology nurses often know why we get into oncology nursing and nursing overall, but it's much easier for us to answer, "What do you do as a nurse" on that outer circle instead of "Why do you do what you do?" I flipped that general conversation of starting to think more about why it is what we do, and that will help us to really answer what we do. I also had some open Q&A questions, which we've started to get some feedback on. I asked this question in the beginning and then the end, using the chat function—"What's one word you could use to describe your current practice as an oncology nurse?"

Looking at those responses first at the beginning of the presentation and then when I asked it again at the end, the end was definitely a lot more hopeful and more directed. That's not to say that everything should be positive after my keynote, because one keynote doesn't cure anything. But I think it get folks starting to think about that "why" and how answering that question is able to really fuel them with the passion to continue on in their careers or perhaps pivot in a way, and that's okay too.

Oncology Data Advisor: That's amazing. Congrats again on a successful presentation. It's such a valuable topic in oncology right now. I'm curious, for those one-word responses that you mentioned, what were some of the different responses before and after the presentation?

Dr. Ghazal: It was interesting to see how the responses changed from the start to the end of the talk. Again, they became a bit more hopeful.Before, yes, there were things like rewarding, meaningful, evolving, growing, grateful, changing. But there was also a lot of difficult, challenging, humbling, busy. Then after the talk, the way that it pivoted to me was a lot more reflective, a lot more of things like life-changing, vocation, evolving, ever-changing, bittersweet, influential. There was a little bit more acknowledging that they and we as nurses actually have power over our practice and have an opportunity to amplify our voices as nurses.

I think that is what's really been highlighted during the pandemic—that, sure, we're being asked about our experiences, but there is still a bit of a silencing and a bit of "I don't know what to say right now" or "I can't share exactly what I'm going through because there's still a lot of trauma wrapped up with the pandemic." I think it was a time for folks to really pause and reflect. We also asked at the beginning how long their tenure in nursing has been, and we had folks from within five years to over 40 or over 50 years. Tt was a good reflection for me to look back at it and say, "Even if you're only within five years in practice or if you're 50-plus years in practice, you still can do this exercise and get something from reflecting on why."

Oncology Data Advisor: That's awesome. That must have been really cool to see too. So, you mentioned some of the things like the Golden Circle method for finding your "why." What is some of the advice you have for nurses who are reflecting on this and trying to find their "why"?

Dr. Ghazal: I think it's really hard. What I did was I went through each of those circles and then posed even more questions to think about that. Right off the bat, I mentioned that my "why," which is very personal for me, is to make cancer suck less for AYAs, for adolescent and young adults. That's kind of borrowing from Stupid Cancer's motto. But it stuck with me, and how I answered those questions. Through that lived experience, through my research, and through my own professional experiences as a nurse practitioner and research nurse, all of those things help me to answer the questions around "why." What brings you joy? What are you good at? What does the world need? What's your overall belief in this and why do you do the job that you do?

The takeaway and the advice that I have for nurses on how to find their "why" is that it's okay if this is a multiple year–long process. It's okay if you go back to these questions. I also think that it's a good reflection to do with nursing colleagues. Also, the second part of this, the "how," really benefits from having the discussion about the "why" first and then discussing with other people, because questions around the "how" really get to what sets you apart from your colleagues, how you fulfill your "why," and what your strategy is? The key thing of that is you have to know what you're good at. You also have to know what you're not good at. That can be really hard for an early-career nurse who's just a few years out of nursing school.

You can do things like workplace self-assessments, meeting with your nurse manager, and talking with colleagues about, "I know that I'm not proficient at this yet, or I know I have more questions about this, but I'm also really passionate about this. Can you help me to understand it more? How do I move to gaining that proficiency?" That self-awareness is really important in terms of advice, because that's something it took me a bit to get. You're in nursing school for a while, and if you go on to graduate degrees and doctoral degrees, it's a lot of school. You're supposed to come out and be an expert, but you realize that you're continuously learning, and that is life.

I hope that folks who participants in this took back the overall advice that they can do these activities, but again, perhaps their "why" will change, and that's okay. If their "why" has changed, then perhaps that's why they're not getting fulfillment from their work anymore. Or perhaps, environmental factors aside, that could be leading to discontent with their jobs. That was just to kind of put something in their ears and help them to think about their role and their place in this really sacred profession in a different way.

Oncology Data Advisor: Definitely, that's really awesome advice. My last question for you is, how will finding your "why," or reflecting on it, help nurses to have a fulfilling career personally and help nursing sustainability on a larger scale?

Dr. Ghazal: That's such a great question, and it reflects on my takeaways. It brings in the points that there are significant challenges affecting the sustainability of our nurse workforce, but there also are opportunities, which I mentioned, in areas for innovation among oncology nurses. We know that delivering effective, sustainable oncology care, whether through your practice, teaching education for nurses, or research, can only be provided by having a robust, healthy oncology nurse workforce. I really believe that when nurses are able to find their "why," whether early in their careers or later on when reflecting back, and when they are okay with the possibility that the "why" could change, it really helps them to either pivot within nursing, pivot outside of nursing, and contribute to the workforce in more substantial ways. This can help our nursing sustainability on a larger scale.

We also think about nurses who are second-degree nurses, and I gave this example in the keynote, for folks to think about how many nurses that they work with who had undergraduate degrees or were coming from an atypical nursing background and entry into nursing. Were they in a business field before? Were they in psychology or social work? Did they have a biology background? For me, I had an economics background. That diversity alone really strengthens the discussions you're able to have with your colleagues in a work environment. I think it helps contribute to these innovative ideas, because we know we can't just be working in silos. I think it also helps to inspire other folks to know that someone got here in a different way or non-traditional and they're still able to contribute meaningfully to our workforce.

Oncology Data Advisor: This is all really awesome advice and such an important topic to be talking about right now. Thank you so much for coming on today and sharing all of this with us.

Dr. Ghazal: Yes, thanks for having me. If you weren't able to catch the Bridge, I think they do have other recorded sessions if you signed up in advance. I'm sure you can share my information if folks want to collaborate or if they want to talk more about this. Like I said, I think it's a really important aspect of cultivating your practice, and from a research perspective, really shaping your program of research and the rest of your career.

Oncology Data Advisor: Absolutely, we definitely will do that. Thank you again.

About Dr. Ghazal

Lauren Ghazal, PhD, FNP-BC, is an Assistant Professor in the School of Nursing and an Associate Member in Cancer Prevention and Control at the University of Rochester Medical Center in New York. Her research focuses on nursing work-related challenges, financial toxicity experienced by adolescent and young adult cancer survivors, and incorporating economic, clinical, and personal experiences to address survivorship disparities.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.