Recommendation:
Nursing care of the cancer patient is provided by nurses with specialized knowledge and skill in oncology.
As an integral member of the multidisciplinary care team, the oncology nurse must possess specialized knowledge and skills to optimize patient outcomes. Oncology nursing services should be coordinated by an experienced oncology nurse who possesses the appropriate level of education, management, and leadership skills to provide effective direction. A plan for initial staff orientation and clinical competency assessment as well as ongoing development and continuing education of the nursing staff should be in place. Nurse competency should be assessed and documented annually.
Oncology nursing practice should be guided by approved policies and procedures in the following areas: administration (all routes) and management of cytotoxic, biological and immunotherapeutic agents; management of oncologic emergencies; management of side effects of disease and treatment; management of vascular access devices and extravasation; management of patients undergoing radiation therapy; comprehensive care coordination to include psychosocial, nutritional, rehabilitative, financial, and spiritual resources and referrals; patient and family education.
American College of Surgeons Commission on Cancer, Optimal Resources for Cancer Care: 2020 Standards, Standard 4.2 Oncology Nursing Credentials.
Oncology Nursing Certification Corporation (ONCC) certification is recommended.
The Oncology Nursing Certification Corporation offers the only oncology-specific nationally accredited certification programs for registered nurses (RNs). Programs for nurse practitioners (NPs) and clinical nurse specialists (CNSs) are also offered through ONCC.
Nurse staffing ratios for oncology care are influenced by a wide array of clinical variables, and differ from the inpatient to outpatient setting. No published standards have been developed by the Oncology Nursing Society (ONS) or the American Nurses Association specific to the oncology patient population, or the oncology site of service (clinic, inpatient, outpatient infusion center).
In the outpatient infusion center setting, a broad range of nurse staffing ratios ranging from 1:4 to 1:8 is seen as acceptable. Staffing in this setting is based on patient acuity, length of therapy and type of treatment being administered (injection, hydration infusion, blood, chemotherapy, biotherapy, etc.). The American Nurses Association encourages hospitals and health centers to create unit-specific staffing plans to account for the patient population treated and level of care delivered on the unit.
Staffing and productivity benchmarking for an ambulatory oncology infusion cancer can be challenging. Shortages in skilled applicants to fill staffing needs may often exist. At Valley-Mount Sinai Comprehensive Cancer Care, the ambulatory infusion center has seen tremendous growth in patient volumes over the past 10 years. Read about their approach to obtaining approval for additional staffing and the creation of an Oncology Nursing Fellowship Program to support recruitment of nursing staff from within.
