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The role of oncology nurse practitioners (ONPs) has evolved over years as the field of oncology has grown. The need for ONPs has multiplied in recent years and their duties and roles have been well established. The ONPs act as direct caregivers, consultants, educators, researchers and administrators. They play a crucial role in providing quality care and services to oncology patients. In order to fulfill their duties, they face a number of challenges and issues. The most important issue is the need for continued education and keeping up to date due to the recent advancements and discoveries in the field of oncology. This is essential for their practice as ONPs and has a great impact on patients’ care, health care institutions as well as personal development of ONPs. This issue has clearly been identified in recent literature and various professional organizations provide good education and training opportunities to ONPs.
Advanced nurse practitioners (ANPs) have slowly gained importance in the field of oncology and play an important role in the management of cancer patients. There is a dire need of oncology nurse practitioners (ONPs) as the field of oncology has grown over time and much advancement has been made. The life expectancy of cancer patients has increased many folds due to earlier detection and better treatment options. Thus, greater numbers of ONPs are required for long term management of cancer patients. Well trained and competent ONPs can be of great help and support to oncologists as they can counsel patients, spend time with them, perform minor procedures and deliver medications. Linda D. Bosserman, MD, president of Wilshire Oncology Medical Group in La Verne, California said, “Before hiring ONPs, we were drowning in work but since taking on ONPs, my practice has more than doubled, and the satisfaction rates are sky-high.” (Davidson).
The role of ONPs is very demanding and their job is very stressful. They have a lot of duties to perform. ONPs play a crucial role in improving healthcare facilities, promoting excellent quality of life for oncology patients and increasing efficiency and cost effectiveness of continued care (Hamric, 2005). ONPs complete their master’s or doctorate degree in oncology to acquire special training, knowledge and skills essential for their practice. They are directly responsible for the quality of care being delivered to all patients. The practice of ONPs includes symptomatic as well as palliative care, health assessment and supervision and prescription of medications. They work as experts in their specialty and help not only patients but also their families and community and promote awareness about cancers and ways to prevent them or detect at an earlier stage when they are treatable. ONPs work in collaboration with oncologists and other nurses to address patient’s problems and concerns. They are also involved in conducting different research studies in their field and make every effort to keep themselves up to date with current knowledge and treatment regimens and protocols. They also act as a liaison between nurses and doctors as well as patients and doctors (Itano, 2005). They are even capable of running individual clinics and managing patients in the absence of doctors. They also meet the psychological needs of the patients and talk to them for hours if the need be. They educate them regarding their health and treatment and even perform procedures like bone marrow biopsy and aspiration, insertion of central line, lumbar puncture, Pap smear and pelvic and digital rectal exam. ONPs deal with patients of all ages, from children to elderly, and work many in different settings, i.e. private hospitals, medical offices, ambulatory care, home health facilities, etc. In short, ONPs can have a position of an educator, researcher, administrator, consultant or direct caregiver (Itano, 2005).
In fulfilling their duties, ONPs face a number of problems and have to deal with a lot of issues. There are several ethical issues involved in their delivery of care and management of patients as they are involved in decision making which is critical for a patient’s life (Itano, 2005). Since they deal with chronically ill patients, there is lack of funds and level of frustration amongst families and patients is very high. This increases the psychological demands of the patients and a lot of time is required for their counseling and satisfaction. As the patients receiving chemotherapy and palliative care are in a devastating and debilitating condition, ONPs are required to maintain their calm under all situations and be strong to take care of such individuals. ONPs may be required to deliver home health care to chronic patients who cannot visit hospitals frequently. A huge obstacle in the practice of ONPs in the lack of accessibility to health care as good quality services cannot be provided in areas which are difficult to access as oncology facilities cannot be developed there. But the main issue faced by ONPs is their educational need due to the recent advances in oncology (Hamric, 2005). The practice of ONPs is very demanding in terms of basic knowledge and current advancements in the field. Recent molecular and clinical research findings have changed the therapeutic paradigm of oncology patients. As different molecular and cellular pathways have been found, new anticancer treatments have been introduced. Since the treatments regimens change rapidly, ONPs not only require a masters or doctoral degree but they should also attend continued medical education programs and seminars regularly.
This issue of continued education has a great impact on patients as ONPs are involved in direct patient care. The newer treatment options have better survival rates and improved outcome and quality of life (Hamric, 2005). Thus, if the ONPs are unaware of these treatment options, the patients will be at a disadvantage as they will not receive the best care and treatment available. Similarly, many treatment options have not been used widely and are relatively new in the field. Thus, their proper implementation and usage also requires sufficient knowledge. Newer practices also require more caution as they can lead to severe adverse effects and deteriorate the condition of the patients. The ONPs should have the knowledge regarding these complications and should be able to treat them effectively.
Clinical education and knowledge is also very important for ONPs for their own success and progress. This up to date knowledge helps them in their day to day management of oncology patients. It also helps them work better as researchers and educators as they can conduct research studies on recent treatment modalities and educate patients and other health professional regarding these advancements. Their education can increase their competency and lead to their promotion to higher administrative positions.
In short, this issue has great implications and can directly affect the patients, the institution where ONPs are working as well as the ONPs themselves. All the health institutions have recognized this need and organize teaching sessions and research seminars and conferences on a regular basis to keep their health care professionals up to date.
Many studies conducted in this area also highlight this issue and show that continued education is the need of every ONP. The article by Belcher focuses on education of ONPs and concludes that there is a need of improvement in the education system and curriculum of nursing practice and postgraduate and short education courses should be introduced to enhance the practice and quality of care delivered by ONPs (Belcher, 1995). A survey conducted on pediatric oncology APNs showed that they prefer continuing education and need for similar opportunities for better patient care (Ferqusson, 1996). A review by Murphy on APN reports that the field of oncology nursing has grown over time and educational adequacy and need is one of the issues faced by the nursing practitioners which needs to be addressed in order to provide expert opinion and care (Murphy, 2002). The interview conducted on new APN students enrolled in master’s program showed that the students preparing for APN programs felt that the education program and studies were stressful and overburdening occasionally but it would definitely have long term personal and professional benefits as it would help them acquire knowledge and skills which would be the basic need for their practice (Williamson, 2006). Similarly, Furlong has also identified that APNs have to face a lot of challenges throughout their practice and therefore, they should have adequate and appropriate knowledge to fulfill their roles and duties and act as pioneers in their profession (Furlong, 2005).
This issue has been addressed in a number of ways. Various professional organizations have been formed which introduce new educational programs and training courses for ONPs. Oncology Nursing Society (ONS) publishes peer reviewed research papers and recent guidelines for reference. They also provide a good network system and quality nursing education (Oncology Nursing Society). Other similar organizations include American Cancer Society, Canadian Cancer Society, National Cancer Institute, etc. various oncology nursing resources include Advances in Oncology, Cancer Connection, CancerNurse.org, Childhood Cancer Research Nurses Group and Association of Pediatric Oncology Nurses (Oncology Nursing Resources). Oncology Nursing Society Foundation promotes nursing education and research by providing funds and grants to nursing practitioners (Oncology Nursing Society Foundation).
In a nutshell, advances in the field of oncology is a great issue for ONPs and it is of utmost importance that they keep themselves updated with the recent discoveries and advancements in this field. For this purpose, proper education programs and curriculum should be designed and professional organizations should organize research seminars and teaching programs on a regular basis. The government should provide support to ONPs for their education and training as it is the dire need of society to have efficient and competent ONPs to deliver quality care.
References
- Belcher. (1995). Education of the advanced practice nurse in oncology. Oncology Nursing Forum , 22, 19-24.
- Davidson, I. (n.d.). ONPs as lifelines.
- Education of the advanced practice nurse in oncology. (n.d.). Oncology Nursing Forum.
- Ferqusson. (1996). A comparison of the educational needs of advanced practice nurses in pediatric oncology: 1987 and 1995. J Pediatr Oncol Nurs , 13, 204-11.
- Furlong. (2005). Advanced nursing practice: policy, education and role development. J Clin Nurs , 14, 1059-66.
- Hamric, A. B. (2005). Advanced practice nursing. Elsevier Health Sciences.
- Itano, J. (2005). Core curriculum for oncology nursing. Elsevier Health Sciences.
- Murphy. (2002). Advanced practice nursing: reflections on the past, issues for the future. Oncology Nursing Forum , 29, 106-12.
- Oncology Nursing Resources. (n.d.).
- Oncology Nursing Society. (n.d.).
- Oncology Nursing Society Foundation. (n.d.).
- Reveley. (2000). Preparation for advanced nursing roles. Nurs Stand , 14, 42-5.
- Williamson. (2006). Change on the horizon: issues and concerns of neophyte advanced healthcare practitioners. J Clin Nurs , 15, 1091-8.
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