The Role of the Advanced Practice Registered Nurse in Oncology Care
Advanced practice RNs (APRNs) in oncology 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. In the Consensus Model for APRN Regulation (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008), APRNs are defined as nurses who have completed an accredited graduate-level education program preparing them in one of four defined roles: clinical nurse specialist (CNS), certified RN anesthetist, certified midwife, or certified nurse practitioner (NP). APRNs have acquired advanced clinical knowledge and skills preparing them to provide direct and indirect care to patients. Their practice builds on the competencies of RNs, demonstrating a greater depth of knowledge. APRNs have greater autonomy in their practice and are able to assume responsibility and accountability for health promotion and maintenance, as well as the assessment, diagnosis, and management of patient problems. Of note, the Oncology Nursing Society (ONS) and Oncology Nursing Certification Corporation (ONCC) are listed as endorsing organizations for the Consensus Model for APRN Regulation (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008).
In addition, the Affordable Care Act includes many provisions that grant further access to APRN care, calling for better use of APRNs to the fullest extent of their knowledge and competence. ONS delineates the scope and standards of advanced practice nursing in oncology (Brant & Wickham, 2013), and ONCC offers advanced practice certification in oncology nursing.
Research substantiates 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 (Cunningham, 2004; Fulton & Baldwin, 2004; Inglehart, 2013; Stanley, 2012).
It is the position of ONS that
- APRN practice in oncology 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.
- APRNs collaborate in care delivery and project design initiatives across the trajectory of care.
- AOCNS® (advanced oncology certified CNS), AOCNP® (advanced oncology certified NP), 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. As such, reimbursement for care provided by CNSs and NPs should be included in federal, state, third-party, and private payer reimbursement systems. ONS supports full integration of reimbursement for care provided by APRNs into all reimbursement settings.
- 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 October 1997, December 1997, February 2001, April 2003, January 2007; reviewed January 2013, January 2014, January 2015, January 2016.
APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
Brant, J., & Wickham, R. (Eds.). (2013). Statement on the scope and standards of oncology nursing practice: Generalist and advanced practice. Pittsburgh, PA: Oncology Nursing Society.
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.
Iglehart, J.K. (2013). Expanding the role of advanced nurse practitioners—Risks and rewards. New England Journal of Medicine, 368, 1935–1941. doi:10.1056/NEJMhpr1301084
Stanley, J.M. (2012). Impact of new regulatory standards on advanced practice registered nursing: The APRN Consensus Model and LACE. Nursing Clinics of North America, 47, 241–250. doi:10.1016/j.cnur.2012.02.001