There are currently no published standards for nurse-patient ratios in oncology settings. In fact, ONS decided not to recommend staffing standards because of significant variations in institutions, patient populations, care settings, and individual patient needs.
ONS did a staffing survey in 2000 addressing perceptions of oncology RNs, oncologists, and nurse executives in both inpatient and outpatients settings related to work environment and staffing in the oncology setting. The results are summarized in two parts by Lamkin et al. (2001 & 2002).
Lamkin et al address the issue of staffing ratios and why ONS decided not to make specific recommendations for staffing oncology nursing areas.
" the imposition of regulations mandating minimum nurse staffing levels or ratios are not supported for a number of reasons…Oncology nurses take great pride in providing individualized patient care. The plan of care created by oncology RNs takes into account patients' and their families' physical, psychological, spiritual, and social needs. Oncology RNs expend great effort keeping up with treatment innovations, technology, patient and family education, and individualized patient care. Nurse staffing must be based on patient acuity, setting, skill and experience of the RNs, available ancillary staff, technology, and each individual patient and family" (Lamkin, et al. 2002, p. 98).
In 2005, Lamkin published an article in Oncology Issues entitled the “Reasons for Not Establishing Oncology Nursing Staffing Standards”. This article validated the findings from the 2000 survey and discussed variations in practice related to patient ratios, staff skill and experience, technology and the practice settings, stating:
“…it is easy to conclude that individualized cancer care may not lend itself to nursing standards. Instead care should be based on patient acuity, the care setting, the skill of the oncology nurse, the presence of other team members, and the availability of technology” (Lamkin, 2005, p. 37).
Resources are being developed that can help guide staffing decisions in oncology settings and are addressed elsewhere in this website section.
Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G.,& Williams, M. (2001). Oncology Nursing Society Workforce Survey Part I: Perceptions of the Nursing Workforce Environment and Adequacy of Nurse Staffing in Outpatient and Inpatient Oncology Settings. Oncology Nursing Forum, 28(10), 1545 - 1552.
Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G., & Williams, M. (2002). Oncology Nursing Society Workforce Survey Part II: Perceptions of the Nursing Workforce Environment and Adequacy of Nurse Staffing in Outpatient and Inpatient Oncology Settings. Oncology Nursing Forum, 29(1), 93 - 100.
Lamkin, L. (2005). Reasons for Not Establishing Oncology Nursing Staffing Standards. In West, S. & Sherer, M. (2009). ISO: The “right” nurse staffing model. Oncology Issues, November/December, 26-30, accessed online at: http://accc-cancer.org/oncology_issues/articles/novdec09/ND09-West-Sherer.pdf