Friese has dedicated his career to researching cancer care delivery and safety issues and shared what he’s learned along the way—not only for the research process, but also his key study findings that have changed oncology nursing practice. 

They’re Opportunities, Not Challenges

Diverse, interprofessional teams and multisite research provide rich data that inform practice and care delivery, but those approaches can also present challenges. Researchers must learn and adapt from failures while recognizing that science is rarely a linear process.

Magnet Doesn’t Create Nursing Excellence, It Rewards It

Friese conducted a study that looked at the nursing practice environment and surgical outcomes. His work was among the early studies to show a significant relationship between unfavorable nursing practice environments and higher mortality following cancer surgery. The findings led Friese to look at whether Magnet hospitals had reductions in 30-day mortality and failure to rescue (i.e., death after a complication) after achieving Magnet status. He found that although Magnet hospitals are slightly superior to matched control hospitals over time, pursuit of Magnet hospital recognition alone was not the defining reason for the better outcomes. “In fact, Magnet hospitals were better to begin with,” he explained, concluding that Magnet is a recognition, not a journey to improved patient outcomes.  

Staffing, Resources, and Procedures Are Essential for Nurse Safety

In another study, Friese investigated the effects of hazardous drug exposure on nursing staff, finding that 17% of respondents reported a chemotherapy spill leading to exposure in skin or eyes during the previous year. Spill incidences were correlated with higher average workload, but when an organization had adequate staffing and resources and required procedures of two nurses verifying chemotherapy, odds of exposure fell by 65% and 83%, respectively.

The analysis also showed that most spills occurred in congested areas and were not entered into risk management software. Additionally, 60% of the nurses did not express concern about the spill and none reported full adherence to personal protective equipment (PPE) recommendations.

Improper PPE Practices Are Persistent and Pervasive

In research, one study often leads to another. His findings led Friese to seek funding for a four-year study to implement and evaluate an intervention to improve nurses’ use of PPE when handling hazardous drugs. He developed a web-based education intervention, with nurses receiving education, quizzes, and emails reminding them about proper PPE use. A subset also received tailored videos addressing personal barriers to PPE use and quarterly reports summarizing hazardous drug spills.

At the study’s conclusion, the nurses in both groups reported the same level of PPE use but both still reported low PPE use. To address the pervasive gaps in practice, Friese developed a novel interprofessional training program (https://mosst.nursing.umich.edu/) on chemotherapy safety.

“We have the obligation and the opportunity to improve cancer care delivery,” Friese added. “Nurse-led cancer care delivery research has the potential to reduce the burden of cancer on patients and families and promote clinician well-being.”