A Purposeful Career Path to Make a Difference in Cancer Care Ruth McCorkle, PhD, FAAN
I have always viewed my nursing career as grounded in clinical practice; I came into nursing because I wanted to make a difference. I had an opportunity to describe my early professional journey in 1995 when Brenda Nevidjon edited Building a Legacy: Voices of Oncology Nurses for the Oncology Nursing Society.1 I will not repeat the details described there; instead, I offer here a brief overview of how my career started as a context for my contributions.
My career began in the early 1960s when I graduated from a diploma program in Baltimore, Maryland. Initially, I worked full time in the operating room while attending night school to obtain my bachelor's degree. Neither of my parents had graduated from college, and it was their value for me to achieve. My education was interrupted when I volunteered for the US Air Force Nurse Corps during the Vietnam War. There was a great deal of social unrest in the 1960s with the assassination of our nation's president and the civil rights movement. Nightly scenes on the television reflected young soldiers in battle, and I felt a calling to step forward, volunteer for military service, and do my share to help. This was a major turning point in both my personal and professional development because my life was quickly overshadowed by continuous contact with critically wounded young soldiers who often died slowly. I became socialized into accepting death as a natural part of war; today, I realize those experiences helped to prepare me to teach others about caring for people who are dying and for their loved ones. I learned then how to be present with patients. I witnessed the unbelievable courage that family members had in living without their sons, daughter, fathers, mothers, husbands, and wives. Along with the chaplain on the base, I would often have to inform families that their family member had been killed. Those experiences with families led me to search the literature to see how others managed disclosing death and what I further could do to help myself withstand the pain and horrors of war.
Initially, I turned to philosophers, poets, religion, and the classics, but I found I needed more concrete descriptions. My search coincided with an explosion of and popularity in the field of death and dying, which led me to the works of giants in the field: Drs Cicely Saunders, Elizabeth Kubler Ross, Jeanne Quint Benoliel, Avery Weisman, and Colin Murray Parkes. By this time, I was completing my master's degree in nursing and was working as a clinical nurse specialist at the University of Iowa. In my graduate program, Drs Ada Jacox and Mary Stewart introduced me to research. Ada drove home to me the importance of theory and how theory has to frame your research questions. But it was Mary who understood the nuts and bolts of doing research, the need for rigor, oversight, and checking and rechecking. The opportunity to practice and see firsthand problems patients were experiencing as a master's-prepared nurse was invaluable in developing my research career. Subsequently, I learned from Ada Jacox that it was essential to obtain a doctorate if I wanted to demonstrate the effects of nursing care on patient outcomes. I completed my doctorate several years later and had negotiated with Jeanne Benoliel for an entry-level tenure track position at the University of Washington. We worked together for 10 years, and in that time, we developed outcome measures to test the effects of clinical interventions and an oncology community-based graduate education program and began a program of research that has spanned more than 3 decades.
In 1986, I relocated to the University of Pennsylvania. I had particular criteria for the setting of my choice, including a graduate program in oncology nursing, a doctoral program, a comprehensive cancer center, and to be within a reasonable distance of Baltimore so I could be geographically closer to my aging parents. At the University of Pennsylvania, my program of research soared. It was a time flushed with research funding and with bright, energetic, and motivated students who wanted to work with me. Because of the geographical location of the University of Pennsylvania to so many other institutions of higher education, there were numerous opportunities for research collaboration and for training across disciplines. I remained at the University of Pennsylvania for 12 years before moving to Yale University. Unlike my previous experiences where I sought employment, Judy Krauss recruited me to Yale University to direct the nursing doctoral program when Margaret Grey transitioned into the position of associate dean of research. I remain at Yale today, teaching in our master's oncology program, supervising doctoral and postdoctoral trainees, conducting my research related to advanced nursing practice outcomes, facilitating the research of others, and striving to change oncology practice based on the evidence of our research.
My career path has been purposeful. I have carefully planned what I have wanted to do in nursing, where to go to do it, and with whom I wanted to work. There have been 4 major themes in my career development, and in each area, I have learned rich lessons. The 4 areas are the science of advanced practice nursing, the process of doing research, the education of nurses, and leadership. The secret to these areas is a delicate balance of working on them consistently and yet giving each area adequate attention so that none of them is compromised. What is amazing is that all 4 areas fit together interdependently and build on each other.
Contributions to Science of Advanced Practice Nursing
My program of research is in the field of psychosocial oncology. I have been fortunate to secure continuous funding and to complete 6 clinical trials testing the role of advanced practice nurses on patient and caregiver outcomes.2 We are currently recruiting patients in our seventh trial. We have published papers about the main findings of these studies, and we have also analyzed the nursing care interventions of what the nurses actually did within the trials. (See Table 1 for publication examples of clinical outcomes and Table 2 for publication examples of the nurses' interventions.) I have also been fortunate to have a number of students complete their own research doing secondary analyses of our clinical trial data.3,4
Contributions to the Research Process
Jeanne Benoliel taught me early on how important it is to document the problems you are experiencing in your day-to-day operations of research and to share these observations with others. These lessons learned can be incredibly helpful to others and facilitate their research as they start on a similar path.5 (See Table 3 for examples of such publications.) As research becomes more sophisticated, regulations require stringent oversight and collaboration. Research is facilitated best in institutions that have resources to help, for example, human subjects committees and data management systems.
Contributions to the Education of Nurses
Since my research has always included testing interventions provided by advanced practice nurses, I have felt an obligation to be connected with a faculty who are teaching the next generation of master's-prepared nurses in oncology. Part of this commitment has included developing standards of education through the Oncology Nursing Society and establishing mechanisms to ensure safe practice through certification requirements. Out of these experiences came a series of articles of what is the essential recommended content at the baccalaureate, master's, doctoral, and postdoctoral levels. (See Table 4 for examples of publications.)
Contributions to Leadership
I have been a member of the American Nurses' Association since 1961, the Oncology Nursing Society since 1975, the American Academy of Nursing since 1979, the American Psychosocial Oncology Society since 1985, and the Institute of Medicine since 1990. In each of these organizations, I have served as a member, officer, member of a standing or commissioned committee, or expert panel. I have also had leadership roles in several international societies. I have had administrative positions both at the University of Pennsylvania and at Yale University in nursing and the cancer centers. In each of these capacities, I have worked collaboratively with others and have been a spokesperson for nursing. (See Table 5 for examples of publications.) I have also served on numerous boards of local and regional organizations, review panels, and editorial board of journals and served as an evaluator for colleagues' appointments, grants, and awards.
Along my journey, I have learned that clinical research is a team activity; it cannot be done in isolation. I have been fortunate to have an array of experienced advisors and mentors. The development of my research career occurred in research-intensive environments where there were well-established infrastructures to facilitate research development. Prior to the advent of technical advances to connect us instantaneously, I sought out people the old-fashioned way by writing to them and traveling to meet them at their institutions. I cannot overemphasize the importance of team building, collaboration, mentors, and consultants. I will never outgrow my need for advisors; they only make my work better.
It is important to establish relationships with colleagues across disciplines, and many of these collaborations can last for a number of years. It is only by working with others to study common problems from varied perspectives that our research grows. By broadening one's own perspective, it logically follows that interdisciplinary activities increase including publishing in nonnursing journals and participating in multidisciplinary organizations through poster and plenary presentations. There have been a number of people I have had the opportunity to collaborate with as a coinvestigator, consultant, or mentor. (Examples of these contributions are listed in Table 6.)
I realize I am a role model for the many young people I encounter daily in my research and training. It is important to take every opportunity we can to promote our colleagues and peers for recognition, awards, and distinguished appointments. There is no greater joy than to be recognized for one's own accomplishments. For over a decade now, I have been privileged to hold the Florence S. Wald Professor of Nursing chair6 at the Yale School of Nursing, but my most honored tribute remains the annual McCorkle lectureship established by the Puget Sound chapter of the Oncology Nursing Society in Seattle every March. I celebrate my 50th year in nursing in 2011.
It is truly amazing to have had the wealth of opportunities I have had and to live during a time of so many revolutionary advances in cancer diagnosis, treatment, management, and technology. In the next decade of my life, I plan to infuse evidence-based cancer nursing care into clinical practice in comprehensive cancer centers and to measure its impact. My best attribute is my generosity. I give freely of my time, my work, my ideas, my enthusiasm, and my opinions. I try to maintain a sense of humor and realize that my children are my greatest critics and remind me on a daily basis not to take life too seriously. We need to take pride in what we have accomplished; our future is bright because we are making a difference in the lives of many future nurses and the patients they will care for. I have been privileged to be a part of nursing and its development over half of a century; it has been an amazing journey and one I hope I have positively influenced and will continue to do so through my research and the students I have taught. Yet when I reflect back on all that has happened, the existential plight7 that patients and families experience has remained the same. A diagnosis of cancer still evokes fear and anxiety, and patients question whether their lives will end prematurely and in pain. These primordial emotions have been the core of my research, to make their diagnosis and treatment bearable so they can go on with living their lives the best they can. I have used the rigor of science to hone in on what nurses do to preserve the humanness of patients and families in cancer care. The essence of what we do is to form a relationship with patients during that raw experience of vulnerability to guide them through their cancer journey. This is what my experience in Vietnam taught me; it was my presence that mattered to the young soldiers and their family members. Avery Weisman has called this "safe passage," and each and every time, forming this relationship is a privilege to be present with another human being, to be available, and to nurse.
1. McCorkle R. Chapter 27. In: Building a Legacy: Voices of Oncology Nurses
. Nevidjon B, ed. Boston, MA: Jones and Bartlett; 1995:312-318.
2. McCorkle R. A program of research on patient and family caregiver outcomes: three phases of evolution. Oncol Nurs Forum
3. Yost L, McCorkle R, Buhler-Wilkerson K, Schultz D, Lusk E. Determinants of subsequent home health care nursing service use by hospitalized patients with cancer. Cancer
4. Van Cleave J, Egleston B, McCorkle R. Factors affecting recovery of functional status in older adults after cancer surgery. JAGS.
5. McCorkle R. Interdisciplinary collaboration in the pursuit of science to improve psychosocial care [published online ahead of print May 25, 2010]. Psychooncology
6. McCorkle R. The Florence Schorske Wald Professor of Nursing endowed chair. Illn Crisis Loss
© 2011 Lippincott Williams & Wilkins, Inc.
7. Weisman AD, Worden JS. The existential plight in cancer: significance of the first 100 days. Int J Psychiatry Med