Supporting Self Education

Jayshree Shah, AOCNP, RN, FNP-C, MSN
Nurse Practitioner, Regional Cancer Care Associates at Hackensack University Medical Center in New Jersey; Nurse Educator, AstraZeneca

Here, Jayshree Shah, AOCNP, RN, FNP-C, MSN, describes the importance of self-education and how her role as a nurse educator has changed during the pandemic.

What is your typical workday like as a nurse practitioner and a nurse educator?

I work in two capacities: as a nurse educator within the pharmaceutical industry during the week, and as a nurse practitioner on the weekends. As a nurse educator, my role is to become familiar with a specific therapeutic area or disease, which, for me, includes chronic lymphocytic leukemia and mantle cell lymphoma. As a nurse practitioner, I am on call and triaging phone calls for the cancer center, which compels me to stay up to date with my clinical education.

My therapeutic territory is broad, which allows me the flexibility to connect with all types of patients with malignancies, advanced practice practitioners (APPs) and oncology nurses.

Most of my “day job” involves reaching out to APPs and oncology nurses at different sites within my territories to share knowledge about therapeutic regimens and recent approvals. My goal is to share whatever knowledge I have with any oncology nurse who is willing to learn. In the area of hematologic malignancies, there is so much to share. That is why I took on this role – I feel like I’m connected to so many different nurses and areas.

In your opinion, what are the biggest challenges nurses and APPs face in terms of staying current in their fields?

Time is our biggest challenge, as with most things. A year and a half ago, I was practicing full time as a nurse practitioner. I worked Monday through Thursday seeing anywhere from 40 to 50 patients each day. Friday was my day off and, on that day, I wanted to talk about anything but medicine. I never seemed to have time for education.

In my experience, you have to be self-directed in your education. No one else can motivate you. You have to make the first step, come with a blank slate, and say, “Please teach me.” At Hackensack, I worked for 8 years with Stuart Goldberg, MD, a leukemia specialist. Then, I shifted to the solid tumor world, working with Martin Gutierrez, MD, who specialized in gastrointestinal (GI) and thoracic oncology at Hackensack and directs its phase I clinical trials program. After working for so many years in one area, my knowledge had become narrowly focused in my specialty. There was a learning curve, but fortunately, I was working in a supportive environment.

Dr. Gutierrez mentored me, providing guidance on exactly what I needed to learn – and how to learn it. He recommended I attend tumor boards, grand rounds, and conferences related to lung cancer and oncology nursing. He also suggested I connect with different institutions to see if they offered education for APPs in this space.

So, I attended early morning thoracic and GI tumor boards, where the group would select five or six patient cases to review, explaining the patient history, the presentation, the pathology, the procedures that were performed, and then, eventually, deciding next steps for managing the patient’s disease. Being part of these discussions helped me understand my role on the care team as an APP.

An APP is the connection at all points for the patient and their caregivers – from diagnosis to treatment, symptom management, maintenance, and supportive care. Attending these tumor boards helped me understand diseases better and the rationale behind the treatment plan, and how I could bring that information to my patient visits. I think patients appreciated that. It was wonderful – absolutely worth waking up so early in the morning to be there!

What tools and resources do you recommend to oncology nurses or APPs to maintain their education?

There is no one-size-fits-all approach to keeping pace with advances in science and medicine, but the greatest resource for APPs who want to continue growing their knowledge is support from one’s institution. Many organizations are still trying to understand an APP’s role. Allotting educational time for them is not something they are thinking about and, at the same time, APPs are stressed about carving out that time for themselves.

When I was transferring to the solid tumor world, I was fortunate that my center offered grand rounds and conferences. Institutions should build dedicated education time into their oncology nurses’ and APPs’ schedules, time separate from patient care, to learn something new and keep up with their continuing education requirements.

If an oncology nurse remains stagnant – just continuing to apply what he or she already knows – they will never grow. We build self-confidence and self-worth by learning, applying new knowledge, and then sharing it.

There are a variety of conferences offered for oncology nurses and APPs, from stand-alone meetings specifically for nurses and APPs to specialized sessions within larger meetings. Now that medical meetings are going virtual, the access to different conferences has expanded – that’s huge. Social media is also a great way to find educational opportunities.

On the other hand, maintaining your education doesn’t need to be a huge undertaking. There are multiple avenues through which we get our information – from apps to e-newsletters. For example, when I get an email from ASH Clinical News Alerts, I scan it for information relevant to my practice, I can review what’s happening in my area of focus in 2 minutes, and I can say, “A new indication was approved for this drug. Let me look into it more when I have time to see how I need to adjust.”

How has your work as an educator changed during the COVID-19 pandemic?

The COVID-19 pandemic has been a traumatic experience for everybody, particularly in health care. It changed the way I do my job, and it is also forcing us to reevaluate how we stay up to date in our area.

My work as an educator shifted in the spring when everything shut down and I was unable to visit hospitals or institutions in person. It provided me time to reflect on updating my knowledge about the disease states and how I communicate with nurses and APPs – particularly in inpatient centers where the workflow is more predictable. Typically, my focus is on outpatient centers and cancer centers, but the pandemic reminded me, “There are oncology nurses everywhere!” As centers started reopening in the late summer, I continued providing them additional education.

The pace of new drug approvals and research in hematologic malignancies is astounding – even during the COVID-19 pandemic. The worlds of leukemia, lymphoma, and transplant have expanded rapidly just over the past 6 months, and I’m still catching up myself. These days, I keep up through virtual education. During the COVID-19 pandemic, I had the time to pause, to learn, and to process what I had learned, rather than constantly rushing at work.

Do you think that these shifts will be permanent?

The pandemic is giving us time to reevaluate, reboot, and reorganize in both clinical practice and education. In the education sphere, having these tools available virtually is wonderful because we can access them at our leisure and when it works best for our schedules.

The virtual format also connects us to colleagues around the U.S. For example, I have tuned in regularly to webinars and interviews with practitioners who explain how their centers are adapting to the new COVID-19 regulations or adjusting schedules. People are developing their own policies and sharing them with the entire health care community – whoever is interested can log in to participate. We all hope that the pandemic will end soon, but we are fortunate to be able to connect virtually. The pandemic won’t stop us from continuing our education – we will always find ways to adapt.