What is an oncology clinical nurse specialist?

Subspecialties: The oncology nurse clinical specialist may choose to specialize in a particular cancer practice working with a selected population of patients. Examples of specialties include medical hematology oncology, hematology oncology, outpatient radiation, outpatient hematology oncology, outpatient pediatric oncology, and palliative care.

Cancers treated: Depends on area of specialty

Training and certification: The oncology clinical nurse specialist completes a bachelor’s degree in nursing and a master’s degree in nursing with appropriate clinical practicum from an accredited graduate nursing program. Education programs will vary, but the master’s degree generally takes about two years to complete and requires at least five hundred hours of clinical practicum. Required courses for a master’s degree vary from school to school. Courses included in these programs are advanced physiology and cancer pathophysiology, pharmacology, cancer genomics, epidemiology, disease and symptom management, palliative care, nursing research, nursing and medical ethics, public policy, leadership, health care financing, health program planning and evaluation, technology use, and advanced nursing concepts. Practicum hours are usually accrued in the nurse’s chosen specialty.

Additional training and skills necessary to effectively practice in the role of oncology clinical nurse specialist include crisis management, in-depth knowledge of the chosen clinical cancer specialty, maturity to take responsibility for patients’ lives, understanding of medical ethics, teaching proficiency, and expertise in interpersonal relations to work with the patient, caregivers, and multidisciplinary health care team. Oncology clinical nurse specialists must have valid nursing licenses issued by the boards of nursing in their states.

In some states, oncology clinical nurse specialists must also receive certification by successfully completing examinations in their specialty. In other states, attaining certification status is voluntary. Proficiency is validated through examination based on predetermined standards and given by a nongovernment agency. The Oncology Nursing Certification Corporation provides several different certifications for nurses working with cancer patients. The Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) certification examination is available to professional nurses who hold a current, active license that is nonrestricted, have completed a master’s degree or higher from an accredited school of nursing, and have completed a minimum of five hundred hours of supervised clinical practice in oncology nursing. Documentation of the supervised clinical practicum hours is required and verified before certification is granted. AOCNS certification is valid for four years. The AOCNS nurse can renew certification three ways: combining practice hours and professional development points, combining practice hours and a successful test result, or combining professional development points and a successful test result.

Services and procedures performed: Oncology clinical nurse specialists can work in a variety of settings, including hospitals (acute care), clinics, long-term care or elder care homes, home care or hospice agencies, and private and joint practices. They can also work as consultants. The oncology clinical nurse specialist recognizes and values the expanding and evolving nature of cancer care and remains current with complex services, procedures, and treatments. The services and procedures performed depend on the setting and function of the nurse’s specific role.

Some oncology clinical nurse specialists work as clinicians and provide direct care for patients and caregivers. They often work alongside other health care professionals such as physicians, nurses, and therapists to plan and evaluate patient care. These nurse specialists schedule and coordinate diagnostic and therapeutic procedures or tests for oncology patients. They will monitor the test results and revise the cancer patient’s care plan based on individual and changing needs. At a cancer care clinic or oncology hospital unit, the oncology clinical nurse specialist may perform the initial admission assessment for new patients and develop the plan of care. This nurse will monitor the plan of care and make adjustments as indicated for the individual cancer patient. The nurse assists with discharge planning to include referrals for other community resources or establish follow-up appointments to physicians’ offices or cancer care clinics.

Oncology clinical nurse specialists often function as teachers. In clinical settings, these nurses keep abreast of current research and new therapies. They use their expanded knowledge of cancer and cancer treatment to teach new concepts or treatment modalities to staff members and members of the multidisciplinary health care planning team. In the hospital cancer unit or cancer care clinic, oncology clinical nurse specialists help assess current staff education, develop new educational strategies, coordinate educational agendas, and revise teaching programs. Educational programs are provided as in-service programs or as clinical practicums. They serve as advisers to staff and other professionals. The goal of this education is to organize and implement an educational strategy that trains professional caregivers to provide the best possible cancer care for patients and their caregivers.

Cancer care education is critical for the cancer patient, family, and caregivers to live life to the fullest. The oncology clinical nurse specialist builds a relationship with the cancer patient and caregivers and provides individualized patient teaching. Cancer patients need accurate and up-to-date information about their disease and treatment options to make decisions about their care. The highly educated and informed oncology clinical nurse specialist is often the person who spends time with the patient and family, teaching them necessary components of self-care and disease management. Even after discharge from the hospital cancer care unit, the patient and caregivers may contact the oncology clinical nurse specialist with questions and concerns. The positive relationship developed during hospitalization often carries over to the home setting as the oncology clinical nurse specialist fills the role of consultant and educator.

Administrative functions are sometimes part of the services delivered by oncology clinical nurse specialists. They monitor the medication regimen of the cancer patient and suggest changes when needed for improved patient outcomes. Sometimes they manage the research protocol as primary investigator for grants and clinical studies. Oncology clinical nurse specialists are stewards in fiscal management of resources by keeping an eye on cancer care costs, noting where services can be delivered more efficiently.

Related specialties and subspecialties: Oncology clinical nurse specialists can work in a number of subspecialties depending on their interests and the positions available in the nurses’ area. Roles are evolving and diverse, as the oncology nurse clinical specialist contributes many skills to the health care team. Some assume administrative roles and perform in high levels of leadership within the cancer care settings. For example, oncology clinical nurse specialists can become nurse managers over specialized hospital oncology units or serve as directors of community cancer care centers, or they might become health care administrators for managed care or insurance companies and consult with key decision makers about covered services for cancer care patients.

Oncology clinical nurse specialists can pursue further education and receive a doctorate degree in various academic fields. One example is the oncology clinical nurse specialist who completes a doctorate and enters the field of cancer research. Another nurse might earn a doctorate in nursing science or a doctorate in education and join a university graduate faculty to teach others to become oncology clinical nurse specialists. As faculty, these nurses can work as consultants and mentors to undergraduate nursing students to help them become proficient in cancer care. Some pursue additional education to function in the dual role of oncology clinical nurse specialist and nurse practitioner. Still others assume an entrepreneurial spirit and use their knowledge and skills in creative and innovative private and joint practice.

Bibliography

Blaseg, Karyl D., Penny Daugherty, and Kathleen A. Gamblin. Oncology Nurse Navigation: Delivering Patient-Centered Care across the Continuum. Pittsburgh: Oncology Nursing Society, 2014. Print.

Camp-Sorrell, Dawn, and Rebecca A. Hawkins. Clinical Manual for the Oncology Advanced Practice Nurse. 3rd ed. Pittsburgh: Oncology Nursing Society, 2014. Print.

Carper, E., and M. Hass. “Advanced Practice Nursing in Radiation Oncology." Seminars in Oncology Nursing 22.4 (2006): 203–11. Print.

Skilbeck, J., and S. Payne. “Emotional Support and the Role of Clinical Nurse Specialists in Palliative Care.” Journal of Advanced Nursing 43.2 (2003): 521–30. Print.

Yarbro, Connie Henke, Debra Wujcik, and Barbara Holmes Gobel. Cancer Nursing: Principles and Practice. 7th ed. Sudbury: Jones, 2011. Digital file.

Yarbro, Connie Henke, Debra Wujcik, and Barbara Holmes Gobel. Oncology Nursing Review. 5th ed. Sudbury: Jones, 2012. Print.

Zuzelo, Patti R. Clinical Nurse Specialist Handbook. Sudbury: Jones, 2007. Print.

Organizations and Professional Societies

National Association of Clinical Nurse Specialists
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http://www.nacns.org, 100 N. 20th Street, 4th floor, Philadelphia, PA 19103.

Oncology Nursing Certification Corporation
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http://www.oncc.org, 125 Enterprise Drive, Pittsburgh, PA 15275.

Oncology Nursing Society
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http://www.ons.org, 125 Enterprise Drive, Pittsburgh, PA 15275.