Education of the Nurse Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy

Education of the Nurse Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy

Specialized education, preparation, and training of the nurse who administers and monitors chemotherapy and biotherapy can ensure a safe level of care for individuals receiving and the clinicians administering these agents. Several professional organizations emphasize chemotherapy/biotherapy education and competency demonstration as a critical component of training to ensure patient and workplace safety (Neuss et al., 2013). To meet accreditation requirements set by the American College of Surgeons Commission on Cancer (2012) standards, practice settings must incorporate nursing education and competency evaluation in oncology practice in all areas in which cancer care is provided. The Oncology Nursing Society (ONS) defines a standardized approach to educating nurses working in oncology and other care settings who administer and care for patients receiving chemotherapy and biotherapy.
The breadth of chemotherapy, biotherapy, and immunotherapy agents continues to expand with the approval of new treatments and new indications for existing therapies. Health care continues to experience a shortage of some essential chemotherapeutic drugs (Christi, 2015). Biosimilar products may bridge a drug availability gap for some critical drug shortages. The term biosimilar describes a biologic product that is proven to be highly similar to a referenced, known biologic product, although minor differences in clinically inert components may exist (Code of Federal Regulations, 2012).
Guidelines and recommendations for oncology nurses providing chemotherapy and biotherapy are described in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich, Olsen, & LeFebvre, 2014) and the voluntary, consensus-based American Society of Clinical Oncology/ONS Chemotherapy Administration Safety Standards (Neuss et al., 2013). These and other publications describe the basic clinical content necessary to provide didactic information regarding the safe and competent administration of chemotherapeutic and biologic drugs (Gullatte, 2014; Wilkes, 2011). Didactic learning must be followed by the successful completion of a clinical practicum under the auspices of the nurses’ institution or supporting agency. Resources addressing the use of biosimiliars in cancer treatment are in development.
It is the position of ONS that
  • RNs are the professional nurses responsible for all aspects of administering and monitoring chemotherapy and biotherapy agents. State practice acts should be consulted when developing institutional policies and procedures. 
  • All introductory and annual competency reassessment programs developed for nurses administering chemotherapy and biotherapy include current and evidence-based content regarding chemotherapy, biotherapy, immunotherapy, and biosimilars for these agents, including:
    • Types, classifications, and routes of administration
    • Pharmacology of agents, regardless of indications for use
    • Pertinent molecular biomarkers
    • Chemotherapy and radiotherapy protectants
    • Principles of safe preparation, storage, labeling, transportation, and disposal of agents
    • Administration procedures, including administration schedule, dose, and route; patient consent; and appropriate documentation in the medical record
    • Specific to biosimilar products: (a) the presence of similarities and differences to the reference product; (b) an evaluation of analytical, clinical, and non-clinical data conducted in a patient population, if available, similar to that of the intended recipient; (c) an evaluation of additional clinical data, if any, reported as a requirement to obtain approval; (d) the appropriateness of use for the patient’s condition
    • Appropriate use and disposal of personal protective equipment
    • Process to ensure patient safety
    • Assessment, monitoring, and management of patients receiving therapy in all care settings
    • Patient and family education for these agents, specific to side effects and related symptom management, and process for urgent follow-up
    • Assessment of, education on, and management of post-treatment care, including urgent follow-up care procedures, late or long-term side effects, and physical and psychosocial aspects of survivorship
ONS provides two courses that set the standard for education of the nurse administering chemotherapy, biotherapy, immunotherapy, and biosimilars. These courses include all content required for the RN to safely and competently administer chemotherapy and include a two-year renewal cycle.
  • Chemotherapy and Biotherapy: Fundamentals of Administration provides the essential information to best prepare all nurses to safely administer chemotherapy and biotherapy.
  • The ONS/Oncology Nursing Certification Corporation Chemotherapy Biotherapy Certificate Course builds on the fundamentals course to increase the expertise of nurses by providing greater detail on safe handling and administration and recommendations for care for those receiving chemotherapy and biotherapy.
Approved by the ONS Board of Directors, 1992; revised July 1997, June 1999, November 2002, July 2005, October 2007, January 2011. Reviewed October 2012, January 2013, January 2014, January 2015. Revised April 2016. Download this position statement.



American College of Surgeons Commission on Cancer. (2012). Cancer program standards 2012: Ensuring patient-centered care [v.1.2.1]. Retrieved from

Christi, L., & Deisseroth, A. (2015). Development and approval of biosimilar products. ASCO Post. Retrieved from,-2015/development-and-approval-of-biosimilar-products.aspx

Code of Federal Regulations. (2012). 42 U.S. §262. Regulation of biological products. Title 42—Public health. Retrieved from

Gullatte, M. (Ed.). (2007). Clinical guide to antineoplastic therapy: A chemotherapy handbook (2nd ed.). Pittsburgh, PA: Oncology Nursing Society.

Neuss, M.N., Polovich, M., McNiff, K., Esper, P., Gilmore, T.R., LeFebvre, K.B., Schulmeister, L., & Jacobson, J.O. (2013). 2013 Updated American Society of Clinical Oncology/ Oncology Nursing Society Chemotherapy Administration Safety Standards for the safe administration and management of oral chemotherapy. Oncology Nursing Forum, 40, 225–233.

Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society.

Wilkes, G. (2011). Targeted cancer therapy: A handbook for nurses. Sudbury, MA: Jones and Bartlett.