Michelle Leonard is a family nurse practitioner at Whittingham Cancer
Center at Norwalk Hospital in Norwalk, Conn. Sheila Grossman is a
family nurse practitioner with a PhD. She is the coordinator of the
family nurse practitioner specialty track at Fairfield University in
Fairfield, Conn., where she is a professor in the program.
The field of oncology offers opportunities for nurse practitioners to play unique roles in all its subspecialties, including medicine, surgery, radiation, oncology research and survivorship. Nurse practitioners who specialize in oncology provide triage for oncologic emergencies and medical management of oncology patients. They also implement interventions based on results of evidence-based studies. The oncology specialty is in demand: An estimated 1.5 million new cases of cancer were diagnosed in 2009.1
The Role
Table 1 outlines common responsibilities of the oncology NP. Oncology NPs may be employed in private oncology practices, emergency departments, surgical centers, community health clinics, disease-specific oncology clinics and hospitals. Oncology NPs are typically graduates of oncology nurse practitioner education programs or more generalized NP programs (family, adult or pediatric; Table 2).
NP certification in oncology is available through the Oncology Nursing Certification Corporation. Approximately 2% of NPs are certified in oncology, but the number of NPs who specialize in this area is larger because many started working with cancer patients before certification became available.
The Oncology Nursing Society developed peer-reviewed oncology nurse competencies in 2007. View them at www.ons.org/publications/media/ons/docs/publications/npcompentencies.pdf. The oncology NP role encompasses practice and leadership. The practice portion involves providing or assisting with management of the oncology patient's disease process and resulting complications. Leadership is needed to ensure that the multidisciplinary team delivers specific aspects of care, meets safety standards, participates in research trials and maintains current and increasing new knowledge. Table 3 provides patient care resources for NPs who work in oncology.2 The intensity of clinical research in cancer treatment has produced rapid developments in biological modifiers, genomics, chemotherapy, surgical techniques and radiation protocols. It is imperative for oncology NPs to keep current with new evidence-based research. For example, the oncology NP may need to discuss options with young oncology patients preparing for ovary or testicle removal that would preserve fertility options without negatively affecting cancer prognosis.3
In another common scenario, an oncology NP may run an adult cancer survivor program in which he or she manages patients' care, assesses for cancer recurrence, manages symptoms that occur secondary to treatment and provides cancer screening.4
Another common need is the treatment of frequent sleep-wake disturbances. Research points to the pathophysiology of cancer as the culprit; it may influence sleep interruption, circadian rhythms and hypothalamic-pituitary-adrenal axis regulation.5 The day-to-day role of an oncology NP in an outpatient cancer center is well defined.6 The competencies document describes the multiple facets of the NP role in oncology. For example, the oncology NP assists the patient and family with making decisions about treatment, including how a patient wants to live out the last stage of life if he or she has a terminal prognosis. Most people prefer to die at home, but circumstances such as severe pain, shortness of breath and insufficient caregiver resources make this wish difficult to fulfill.7 Research indicates that the closer interaction the terminal cancer patient has with the healthcare team, the more positive his or her end-of-life experience.8 Using this evidence, NPs can ensure that each terminal oncology patient has a mutually decided upon plan.
Oncology NPs often carry additional responsibilities such as sharing weekend and on-call duties, serving on department- and system-wide committees, and providing health teaching and consultancy at community healthcare summits.
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