The Role of the Advanced Practice Nurse in Oncology Care

Advanced practice oncology nurses provide leadership to improve outcomes for patients with cancer and their families by increasing healthcare access, promoting clinical excellence, improving patients' quality of life, documenting patient outcomes, and increasing the cost-effectiveness of care. The American Nurses Association ([ANA], 2004) defined advanced practice registered nurses (APRNs) as “RNs who have acquired specialized knowledge and skills to provide health care (p. 14)” and are expected to hold a master's or doctorate degree in their specialty. Furthermore, ANA noted that APRN is the umbrella term used to identify the advanced practice roles of certified registered nurse anesthetist, certified nurse midwife, clinical nurse specialist (CNS), and nurse practitioner (NP) and stated that “although the scope of practice for each of these advanced practice registered nurses is distinguishable from the others, there is an overlapping of knowledge and skills within these roles” (ANA, p. 14). The Oncology Nursing Society (ONS) has delineated the scope and standards of advanced practice nursing in oncology (Jacobs, 2003), and the Oncology Nursing Certification Corporation offers advanced practice certification in oncology nursing.

Research has substantiated the positive impact of APRNs. Significant outcomes include increased access to care and patient education; improved patient satisfaction, cost-effectiveness, and patient compliance; fewer hospital admissions; and decreased lengths of stay, readmission rates, emergency care visits, and healthcare costs (Brooten & Naylor, 1995; Cunningham, 2004; Fulton & Baldwin, 2004).

It Is the Position of ONS That

• APRN practice in oncology nursing includes CNSs, NPs, and dually prepared (CNS and NP) nurses who are prepared at the graduate level (i.e., master's or doctorate) with a specialty focus in oncology practice.
• APRNs are authorized by their state-defined nursing practice acts to work independently or in collaboration with a designated physician partnership.
• AOCNS (advanced oncology certified clinical nurse specialist), AOCNP (advanced oncology certified nurse practitioner), and AOCN^® (advanced oncology certified nurse) credentials are validation by the professional nursing community that the bearers of the credentials have advanced and specialized knowledge in providing and coordinating quality cancer care for adults from diverse populations and settings.
• Where states include professional certification in regulatory requirements, the AOCNS, AOCNP, and AOCN^® credentials are accepted as recognition of advanced oncology nursing practice.
• All APRNs are offered the opportunity for prescriptive authority, following specific education and experience, to best meet the needs of patients throughout their cancer experience.
• State statutes and regulations recognize the unique and distinguishable differences between the APRN roles and should create regulations that facilitate the practice of oncology CNSs and NPs while removing regulatory barriers that deny the public access to APRN services.
• Consumers have a full choice of healthcare providers, including APRNs.
• Reimbursement for care provided by CNSs and NPs is integrated into federal, state, third-party, and private- payer reimbursement systems.
• Funding is authorized and appropriated for nursing research to further document and evaluate the outcomes of advanced oncology nursing practice.
• Oncology APRNs are integrated fully into all aspects of cancer care and health policy reform.

Approved by the ONS Board of Directors 1995; revised 10/97, 12/97, 2/01, 4/03, 1/07

References

American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington , DC : Author.

Brooten, D., & Naylor, M. (1995). Nurses' effect on changing patient outcomes. Image—The Journal of Nursing Scholarship, 27, 95–99.

Cunningham, R.S. (2004). Advanced practice nursing outcomes: A review of selected empirical literature. Oncology Nursing Forum, 31, 219–232.

Fulton , J.S., & Baldwin, K. (2004). An annotated bibliography reflecting CNS practice and outcomes. Clinical Nurse Specialist, 18, 21–39.

Jacobs, L.A. (Ed.). (2003). Statement on the scope and standards of advanced practice nursing in oncology (3rd ed.). Pittsburgh , PA : Oncology Nursing Society.