November 13 to 19 is dedicated to National Nurse Practitioner Week, and the Association of Community Cancer Centers (ACCC) is taking this opportunity to recognize its nurse practitioner (NP) members—highlighting the work NPs do to improve access to care, the patient and clinician experience, and patient outcomes.
To start, ACCC recognizes the deep need NPs—and other advanced practice providers (APPs)—meet as the oncology workforce across the United States grapples with staffing shortages and turnover rates. “These individuals work with their physician colleagues to provide safe, cost-effective care,” the association said in a 2021 news release, adding that APPs “improve practice workflow and efficiency, enabling physicians to care for more patients and focus on those who need complex care.”
Access the virtual summit executive summary to learn more about the value APPs bring to the multidisciplinary team, including how they can drive and foster engagement in elevating equity through personal education and action, leadership within professional organizations and healthcare facilities, research and publications, and advocacy.
Patient health literacy is an essential—but often lacking—aspect of quality cancer care. Particularly when patients receive a diagnosis unfamiliar to them, they need tools to understand the facts, so they can make informed treatment decisions with their care team. Theresa Roelke, MSN, RN, AGNP-C, a geriatric nurse practitioner at MaineHealth, Maine Cancer Care Network, says that when people receive news of a lung nodule after screening, they are often distressed. “What I was finding is that patients look at their radiology report, and it looks pretty scary because they don't understand it,” she explained to ACCCBuzz. “They don't understand the medical language, and they're at a loss.”
Winning a 2020 ACCC Innovator Award for MaineHealth, Maine Cancer Care Network, Roelke developed a 3-D lung nodule tool to improve patient education following a low-dose computed tomography (LDCT) scan. This tool can be used in any clinic setting where imaging is being discussed to support patients’ health literacy and shared decision-making.
In May 2018, Roelke piloted the tool’s use during shared decision-making consults with patients to address the significance of nodule size, appearance, and malignancy risk. Preliminary pilot data indicate that patients found the 3-D lung nodule tool helpful, improving their understanding of lung nodules and the significance of nodule size and appearance. “The end goal is to disseminate the tool to lung screening programs and pulmonology clinics throughout New England and then across the country to improve patient education and shared decision-making around LDCT screening in both the inpatient and outpatient setting,” Roelke said in her Oncology Issues article.
“At present, one stumbling block to advancing the role of APPs in cancer care delivery is existing regulatory and practice variability,” said Archana Ajmera, MSN, ANP-BC, AOCNP, advanced practice provider supervisor at the University of California San Diego (UCSD) Moores Cancer Center, in her Oncology Issues article. “For example, advanced nursing practice is regulated at the state level and, therefore, scope of practice, regulations, and licensure vary state to state.” Allowing APPS, including NPs, the privilege of signing orders for intravenous anti-cancer therapies decreases delays in patient care and infusion center workflows, while increasing patient and provider satisfaction in their care experience.
After launching an initiative to propose a policy change for NPs and physician assistants to sign intravenous anti-cancer therapy orders at UCSD Moores Cancer Center, Ajmera and her team did not establish a compulsory process that required these clinicians to attain privileging. “Since the start of the program in 2019, half (52 percent) of eligible oncology APPs have applied for and received privileging,” Ajmera said. “Currently, 9 of 14 ambulatory hematology/oncology APPs are credentialed.”
Further, the new privileging workflow at UCSD Moores Cancer Center allows APPs to better support their clinician colleagues throughout the COVID-19 pandemic. By utilizing telemedicine and offering APP-led visits when clinicians’ schedules are full, patient access to care is improved.
With the understanding that patient education about palliative care is an important component of oncology care, Cancer Care Associates of York implemented an APP-physician model to provide this education. “Given that we practice in oncology, we know that palliative care issues are not new," Jia Conway, DNP, CRNP, AOCNP, a nurse practitioner at Cancer Care Associates of York, said to ACCCBuzz. “The issues that were arising in our practice were fragmentation of care and identification of high-risk patients—those who are sick before they start treatment or those who have complications during treatment.”
To better keep patients in active treatment out of the hospital and prevent delays due to adverse reactions, Conway spearheaded the development and implementation of a comprehensive community-based palliative care program at her practice—winning her and the practice a 2021 ACCC Innovator Award. Through this program, staff identify high-risk patients and introduce them before the start of treatment to an APP who teaches patients and family members about palliative care and its benefits.
Conway says that a key part of her program’s success is teaching everyone in her practice about palliative care and why it is important to offer this care to patients early in their anti-cancer treatment. “There are so many moving parts that you need to find out what works and what's going to be reasonable for all the team players who you're going to need to help you make this come to fruition,” she said.
In 2018, Christa Braun-Inglis, MS, APRN-Rx, FNP-BC, AOCNP, left her full-time clinical oncology practice to become an NP/assistant researcher at the University of Hawai’i Cancer Center and a clinical faculty member at the University of Hawai’i School of Nursing and Dental Hygiene. “I have a hybrid position, in which I am a part-time clinician working with breast cancer patients and a part-time faculty member supporting clinical research,” Braun-Inglis told Oncology Issues.
Braun-Inglis knew that she was entering a line of work uncommon in her profession. “The common belief was that opening clinical research to APPs would take work away from physicians,” she explained. Braun-Inglis would go on to prove that there is plenty of research to go around and bringing more clinical trials into community cancer centers not only benefits patients, but also enables all clinicians to work at the top of their license.
In her current role, Braun-Inglis is positioned to help bring down the barriers that often stand in the way of other oncology APPs who want to assist with clinical research. “When I joined the University of Hawai’i, I wanted to get more APPs involved in research across the community,” said Braun-Inglis. “I have mentored and helped train 10 oncology APPs in clinical research, and they are all now registered as non-physician investigators through the National Cancer Institute.”
For those cancer program and practices looking to expand its NPs’ role in oncology, Vanderbilt-Ingram Cancer Center has laid out how to develop and support a dedicated-NP, hematology-oncology fellowship program. “The NP fellowship was proposed by experienced oncology nurse practitioners who are often responsible for onboarding newly graduated advanced practice nurses,” said Heather Jackson, PhD, APRN-BC, NEA-BC, FAANP, administrative director of advanced practice at Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, and authors in their Oncology Issues article. “These highly specialized NPs approached administrative leaders with the idea of creating a hematology/oncology NP fellowship to deliver specialized oncology training and ensure successful transition into practice.”
In a two-month period, the cancer center saw 33 qualified NPs apply to its fellowship program. After dedicated staff conducted a thorough review of applications and completed the interviewing process, two NPs received an offer to participate in the program. Both NPs demonstrated improved self-confidence and were deemed proficient in practice across multiple cancer specialties by their advanced practice preceptors after completing the 12-month NP fellowship program. “The established curriculum ensured effective preparation, which resulted in advanced knowledge and clinical competency and improved provider self-confidence and perceived self-competence,” concluded Jackson et al.
Join the American Association of Nurse Practitioners this week in celebration of nurse practitioners in every specialty via #NPWeek on social media.
We welcome you to share our blog content. We want to connect people with the information they need. We just ask that you link back to the original post and refrain from editing the text. Any questions? Email Chidi Ike, Content Manager.
To receive a weekly digest of ACCCBuzz blog posts each Friday, please sign up in the box to the left.