ONS Recommendations for Oncology Staff Assignments During the COVID-19 Pandemic

As coronavirus infections continue to spread throughout the United States, appropriate and safe staffing plans are needed to meet patient needs across institutions. All healthcare settings where cancer care is delivered face unique staffing challenges as staff shortages add further stress to overburdened health systems. Temporary redeployment of nurses, use of travel and other temporary agency nurses, and room assignments or grouping patients have become essential strategies to fill the gap during recurring COVID-19 surges and rising case rates and hospitalizations. Decisions about applying these staffing strategies to patients with cancer and their care providers must incorporate the following safety factors and associated recommendations.

Oncology population

People with a cancer diagnosis are considered a vulnerable population at risk for more serious consequences if infected with the coronavirus.
Certain malignancies and/or treatments put some patients at even higher risk than the general cancer population. These include patients with hematologic malignancies or neutropenia, blood and marrow transplantation recipients, or patients treated with immunosuppressive drugs.
Most cancer treatments (radiation, chemobiotherapy) are suspended when a patient tests positive for COVID-19 and resume when the patient recovers. Decisions about when to continue or resume treatment are based on the risk to the patient, successful control of the malignancy, and the ability to protect staff, other patients, and the environment.
COVID-19 therapeutics and supportive care interventions (blood products, hydration, clinical trial assessments) are administered in outpatient infusion units and other clinical areas by oncology and non-oncology nurses. As a result, ambulatory cancer infusion centers are caring for patients who are COVID-19 positive and require specific protocols to mitigate infection of staff and other patients.

Oncology care providers

Oncology nurses have specific knowledge and credentials to ensure the safety and quality of the care they provide to patients with cancer. These commonly include chemobiotherapy administration, treatment assessment and monitoring, and IV access device expertise.
Use of travel and other agency nurses and cross-coverage and redeployment of staff nurses without current oncology competencies increases error risk for patients and nurses.
Telehealth has replaced in-person visits for ambulatory patients whenever possible to reduce the risk of exposure to patients and staff. Oncology nurses and advanced practice nurses are performing many telehealth visits collaboratively and independently, adding to the volume of work and staffing burden.

Infection risk

Temporary reassignment or “floating” of oncology nurses to clinical areas with inpatients who are positive for COVID-19 exposes them and their home units’ vulnerable patients and staff to COVID-19 infection.
Inpatient oncology units and ambulatory departments are grouping patients with suspected or confirmed COVID-19 within a designated area or specific patient rooms and scheduling templates.

Recommendations

In this critical time, meeting institutional needs for optimal patient care delivery for a system requires reliance on protocols that reflect the evolving science and interests of the health and safety of all patients and staff.

As nurse leaders face the challenges of ensuring quality patient care with innovative staffing models, ONS recommends the following:

Patients with cancer and infection risk

Identify high-risk populations that are more likely to have serious effects from a COVID-19 infection.
Initiate staffing guidelines.
- Assign the care of high-risk patients with cancer to designated staff who are not caring for patients with suspected or confirmed COVID-19 infections.
- Assign the care of patients with cancer who are COVID-19 positive to a designated cohort of nurses to prevent the risk of cross-contamination to patients and staff.
- When reassigning or floating oncology nurses caring for high-risk patients, especially for episodic or partial shift care delivery, avoid assigning them to areas with suspected or confirmed cases of COVID-19.
Whenever possible, isolate patients with cancer who are COVID-19 positive to an area designated for patients with suspected and confirmed COVID-19. Initiate turnover and cleaning protocols for these areas.

Oncology care providers

Assign administration of antineoplastics by any route to RNs who have completed the required training and competency for safe handling and administration of hazardous drugs as identified by institutional policies and procedures.
Ensure that personal protective equipment, including but not limited to surgical masks and eye protection, is used during routine patient care of those with a suspected or confirmed COVID-19 diagnosis. Depending on the risk for aerosolization and transmission of coronavirus during care, a fitted N95 mask and face shield should also be used.
Consider the burden of telehealth responsibilities on nursing assignments.
Staffing recommendations regarding return to work after a coronavirus diagnosis or exposure are based on data that are evolving rapidly. Nurses and administrators must follow institutional policies and procedures that prioritize the status of healthcare workers and vulnerability of the patient populations they serve.

^{Updated February 2022}