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The COVID-19 pandemic significantly impacted the health care workforce, with 5% of the nursing workforce—approximately 195,000 registered nurses (RNs)—leaving the workforce due to the pandemic.1 While 43% of nurses planned to return, 19% indicated that they did not intend to come back, according to data released in 2024 by the Health Resources & Services Administration.1 The nursing shortage is expected to continue due to limited nurse educators, retirements, and a high turnover rate.2 With so many nurses leaving the profession, cancer programs have been challenged to fill vacancies. These nursing shortages—and a need to support their existing nurses—have caused many cancer programs to rethink how care is delivered and to identify ways to empower patients to manage certain aspects of their own care, such as administering antibiotics, fluids, and total parenteral nutrition, as well as disconnecting from chemotherapy pumps. Teaching patients and caregivers how to care for their central lines and how to disconnect their chemotherapy can be a win-win for all, fostering a sense of control and autonomy for patients and caregivers and removing tasks from busy providers. At least that has been the experience here at Wilmot Cancer Institute, in Rochester, NY, when we have empowered our patients with cancer to independently disconnect their own chemotherapy at home.
In 2025, Una Hopkins, DNP, MSN, FNP-BC, NE-BC, RN, FACCC, announced that her ACCC President’s Theme would be Designing Oncology Care to Meet the Needs of a Growing Patient Population. Wilmot Cancer Institute’s initiative to empower patients and caregivers to self-disconnect from certain chemotherapy infusions directly supports this theme by illustrating a practical and scalable solution to workforce shortages by:
Our Implementation Story
To explore the feasibility of patient self-disconnection, cancer program and nursing leadership convened a discussion regarding potential options. Next, a multidisciplinary committee was established, including nurses from clinic settings, infusion centers, and home care (the University of Rochester [UR] Home Infusion). Over the course of 8 months, the committee met monthly to evaluate and plan implementation. Several key considerations were identified, including ensuring patient safety and resource availability, as well as securing buy-in from both clinicians and staff.
Education is critical to ensuring that patients can perform tasks independently following a 5-FU self-disconnect teaching session. The decision on whether a patient is a suitable candidate for this self-care task is based on the clinical judgment of the nurse or provider performing the self-disconnect teaching session. This decision often includes an assessment of a caregiver’s ability to disconnect the chemo.
Our team created a teaching sheet, including visual instructions and a QR code for the patient to watch a video. Prior to the patient’s first self-disconnect teaching session, a referral to a certified home care agency is made. If both provider and patient feel confident and comfortable with the process after the teaching session, the home care referral is canceled. Otherwise, the referral will remain in place. Patients are given resource sheets to troubleshoot the most common issues, including if the IV pump is not functioning appropriately, and other helpful information to facilitate successful 5-FU self-disconnects. Patients receive phone numbers for UR Home Infusion and for the Eclipse hotline to help answer questions related to the eclipse bulb (the balloon-shaped device that delivers IV medication). Patients also receive a yellow chemotherapy bucket with a preprinted mailing label and instructions; when filled, patients return the bucket by mail. Figure 1 illustrates our 5-FU self-disconnect education process.
Wilmot Cancer Institute operates 10 infusion centers that administer 5-FU. When the patient self-connect initiative was rolled out, the cancer center had 358 patients currently on continuous chemotherapy of 5-FU.
Our Outcomes
Of these 358 patients, 136 received education and were deemed suitable to safely self-disconnect from home. Based on REDCAP survey data, these patients performed this task without any issues. Specifically, 122 surveys were sent to patients, and a total of 55 responses were returned—a 45% response rate. Patient demographics and survey responses are shown in Figure 2. Patient feedback indicated that 5-FU self-disconnects in the home is feasible and allows patients to take part in their care safely. Open-ended comments included:
For our team at Wilmot Cancer Institute, empowering patients to self-disconnect from their chemotherapy infusions represents a significant innovation in patient care. This approach enhances patient competence by giving them the skills and confidence to manage their treatment, fostering a greater sense of control over their health. It also builds trusting relationships between patients and health care providers, as patients are given the tools and support they need to take an active role in their care. The method promotes patient autonomy, allowing them to direct their care and make decisions that best suit their lifestyles and preferences. Specifically, this initiative:
Colleen Tantalo OCN, MNE, RN, is the nurse manager of the UR Home Infusion Pharmacy; Julie Berkhof, DNP, RN, MS, FNP-C, is director at the Wilmot Cancer Institute regional locations; Elizabeth Kiss, DNP, RN, FNP-BC, is assistant director of Wilmot Cancer Institute Quality and Safety; and Timothy J. Warner, RPh, MBA, is director of UR Home Infusion Pharmacy at Wilmot Cancer Institute in Rochester, New York
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