Position Statement on Cancer Nursing Leadership

The Importance of Nursing Leadership

Nurses are essential to effective global cancer control, influencing treatment, education, research, and policy issues—at local, national, and international levels. Empowering cancer nurses to lead and take on key leadership roles across the cancer continuum and within different levels of the healthcare system is imperative to addressing the burden of cancer globally. In some countries, addressing inequalities and dismantling professional hierarchies is central to enabling nurses to exercise their leadership capabilities, even if they are not in a leadership role, to improve cancer care outcomes. Although every cancer nurse will be required to demonstrate skills as leaders, not all will be in leadership roles. More nursing leadership roles are needed at national, regional, and global levels. In some countries, more cancer nursing leadership opportunities are provided/available than in others. For example, in many countries, inequalities and professional hierarchies exist, which often prohibit leadership opportunities for cancer nurses. Investment in developing leadership among nurses at all levels is a global priority.^1,2

Leadership is the ability to achieve collaborative effort, enabling people to work together to achieve common goals. It is multifaceted, characterized by the ability to provide and deliver direction and support, motivation, coordination, collaboration, effective communication, and advocacy for patients, communities, and other nurses. Leadership is about interpersonal relationships, and empowering the workforce to be innovative and creative to solve challenges is going to be important moving forward.³ Strengthening nursing leadership in global health (“no one left behind”) is a priority. The consistent messaging in the “Triple Impact Report,”⁴ the Nursing Now initiative,⁵ and in the State of the World’s Nursing⁶ and the Global Strategic Priorities for Nursing and Midwifery⁷ reports is that influential nurse leaders are more critical than ever. As the most significant global health workforce,⁸ nursing needs to focus its attention on the development of nurse leaders across clinical care, research, education, policy, and administration if the World Health Organization sustainable development goals⁹ and the global strategic priorities for nursing are to be met. The Institute of Medicine report on the Future of Nursing: Leading Change, Advancing Health¹⁰ and more recently the National Academy of Medicine report on the Future of Nursing 2020-2030,¹¹ both call for nurses to lead interprofessional teams and healthcare systems to benefit patient outcomes and system-level efficiency. Not only has the COVID-19 pandemic powerfully illustrated the knowledge, skills, commitment, and leadership of nurses globally, it has also demonstrated why person-centered, culturally safe, evidence-based care and Universal Health Coverage¹² cannot be achieved without nurses and nurse leaders.

Nurses, as informal and formal leaders, need to be fostered and recognized across all aspects and levels of nursing work. Nurses work across all health settings and organizations, often at the highest levels of clinical care, but rarely at the highest levels of management where they can use their voice to influence.¹³ Pathways to develop nursing leadership and nurse leaders need to be fostered and implemented.¹⁴ Research in nursing leadership demonstrates clinical- and system-level benefits,¹⁵ but more research is needed to strengthen the evidence around nurse leadership and particularly in the context of cancer nursing.

What Do We Mean by Cancer/Oncology Nursing?

Cancer or oncology nursing is used interchangeably to describe the nurses who practice in the specialty of cancer care/oncology. However, for this position statement, we also include all nurses working with people affected by cancer, whether they are oncology trained or not, as they all have an important leadership role to play.

Why Cancer Nursing Needs Effective Leadership

Cancer is a common chronic disease with 19.3 million new cases and approximately 10 million deaths reported globally in 2020.¹⁶ As healthcare delivery systems change, and new scientific discoveries are integrated into cancer care, the role of the cancer nurse continues to evolve. Cancer nurses work in a variety of roles and settings that were unheard of 10 years ago but are now increasingly common. These include acute care, ambulatory care, the private sector, and home and community services, along with education, research, policy, and advocacy. They practice within a number of oncologic disciplines, including, but not limited to surgery, radiology, gynecologic oncology, pediatric oncology, medical oncology, hematology, transplant, and cancer genetics.

The era of precision medicine also presents challenges to achieving universal health coverage (within the sustainable development goals). As the global cancer burden increases in lower-income countries, the leadership of cancer nurses in reducing both inequalities and inequities in access to high-quality care has never been more important.

The nursing profession establishes leadership through the practice of individual nurses engaged in patient care, administration, teaching, and research. When empowerment is absent or not utilized, others are more likely to step in and decide what nursing is and what nurses do. Thus, nurses may not identify themselves as leaders or potential leaders. The language of leadership often excludes nurses and has socialized nurses into defining leadership as separate to nursing practice. However, nursing leadership can be “learned.”¹⁷ Globally, nurses can provide leadership in patient assessment, patient education, coordination of care, symptom management, palliative care, education, research, advocacy, and policy. Although many also serve in key management positions such as chief executives or directors of cancer services, it is essential that they are empowered and supported to utilize their leadership skills, whether in key management positions, in academic roles, or clinical practice.

Strengthening nursing leadership is evident across several international cancer nursing position statements, for example, the Canadian Association of Nurses in Oncology (CANO/ACIO) position statement.¹⁸ The CANO/ACIO statement strongly advocates for prioritization of nurse leadership training within academic programs, across cancer care organizations and nursing organizations, who can provide mentorship and coaching. One of the most prevalent opportunities for cancer nurses to influence and lead care is by collaborating and influencing within multidisciplinary teams to address the needs of the patients and family members they care for, often in high-acuity, fast-paced, and under-resourced environments.

Many organizations have identified the competencies required for cancer and palliative care nursing leadership, such as the African Palliative Care Association,¹⁹ the Oncology Nursing Society,²⁰ the European Oncology Nursing Society,²¹ and the African Organisation for Research and Training in Cancer.²²

The International Society of Nurses in Cancer Care is committed to the promotion and development of cancer nursing leadership around the world because of the following:

• Effective cancer nursing leadership is required at all levels of clinical care spanning from newly qualified through to advanced clinical practice, advocates, education, research, and senior health service administration.
• Cancer nurses need the opportunity to practice a range of leadership skills, which includes the following: modeling the way for others, inspiring a shared vision, challenging the process, enabling others to act to their maximum capacity and skills, and encouraging and empowering others.²³
• Cancer nurses enable implementation of future trends in oncology care. Nurses identify ways to change, grow, and improve; create a culture, infrastructure, and practice environment that supports innovation, advancement of cancer nursing practice, and excellence in patient- and family-centered care.
• Collaborate on research strategies development lies not only with schools of nursing and individual institutions but also with professional associations that can collaborate to research strategies and develop effective leadership programs that can be integrated into clinical training.

Call to Action

The International Society of Nurses in Cancer Care is committed to advocating to ensure that cancer nurses can reach their leadership potential for the benefit of patients and their families, and influence local, national, and global cancer control. The International Society of Nurses in Cancer Care recommends the following:

• All nurses working with people affected by cancer, regardless of where they are working, should be supported and encouraged to develop and utilize leadership skills.
• Cancer nurses need preparation to be able to mentor and empower other cancer nurses to develop their leadership skills, actively supporting them and providing, where possible, opportunities for leadership development.
• Leadership skills should be included in formal professional and continuing cancer nursing education, and where possible, leadership fellowships established to develop cancer nurses in a wide range of countries.
• Examples of cancer nurses as leaders across a range of settings should be made available and shared to encourage and empower cancer nurses.
• Leadership training for cancer nurses should be developed that links in with national nursing leadership development programs.⁶
• Cancer nurses should be provided opportunities for training in policy development and advocacy, thus enabling them to lead in this capacity.
• Cancer nurses are enabled to get a “seat at the table” to enable their voice to be heard, at all levels within cancer care, for example, on the ward, in the community, at the administrative levels, and at the national and international levels.
• International Society of Nurses in Cancer Care members work together to contribute to global efforts to build cancer nursing leadership globally.
• Nursing leadership is addressed at all national, regional, and international cancer nursing conferences to stress its importance, but also to empower and encourage new and emerging cancer nursing leaders.
• National, regional, and international cancer nursing and related associations work together to develop cancer nursing leadership globally.