Appropriate nurse staffing levels contribute to the delivery of safe, quality care and optimal outcomes for patients receiving cancer treatment. The nursing shortage negatively affects staffing in patient care areas with direct impacts on patient outcomes (Haddad et al., 2022). Developing nurse staffing models, particularly in the ambulatory setting, is an ongoing challenge. Oncology Nursing Society (ONS) has developed this position statement through a comprehensive review of the existing literature, as well as engagement with members on the topic of ambulatory staffing via surveys, email inquiries, focus groups, and online discussions in the ONS Communities.
In this position statement, the term “ambulatory setting” includes infusion centers that provide various treatments to patients with cancer, including non-chemotherapy treatment (e.g., IV hydration, transfusions), and radiation therapy. These settings share commonalities, including rapid turnover of patients and the administration of some type of treatment or intervention. “Nurse staffing” refers to the clinical nurses in the setting and does not include advanced practice nurses or nurses in other roles.
Oncology treatment continues to transition to the ambulatory setting, and the care needed for patients is multifaceted. Many inpatient staffing models exist, with federal and state regulations often driving the requirements for nurse staffing levels. No standard staffing model or nurse–patient ratio currently exists for ambulatory infusion, chemotherapy, or radiation therapy treatment centers.
In surveys of ONS members, staffing is frequently cited as a top concern. Determining appropriate nurse staffing can be complex, with patient-, personnel-, treatment-, and institution-based variables affecting decisions. Some centers have developed institution-specific tools or implemented commercial products to address scheduling and staffing. Many of these tools are based on perceived acuity rating of patients and may incorporate other factors, such as nurses’ skillsets/experience or time required for prescribed treatments. However, acuity is not measured only by time spent in the infusion center. The care needs of patients and their support systems are complex and can fluctuate throughout the care spectrum.
Additional definitions of terms related to ambulatory staffing are provided by the American Nurses Association (2017, 2019):
It is the position of ONS that:
Approved by the ONS Board of Directors, October 2019. October 2022
Download this position statement.
American Nurses Association. (2017). Defining staffing: Workforce management, patient classification and acuity systems, the request for proposal process. http://bit.ly/33CPGDz
American Nurses Association. (2019). ANA’s principles for nurse staffing (3rd ed.). American Nurses Association.
Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. (2022). Nursing shortage. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Learn about ONS’s stance on the healthcare issues that affect oncology nurses.View All Position Statements