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

As COVID-19 coronavirus infections spread throughout the United States, appropriate and safe staffing is needed to meet patient needs across institutions. Hospitals and cancer centers are facing unique challenges in staffing and redeploying staff to other units. Factors contributing to decisions about temporary reassignment of oncology staff outside of the oncology unit or ambulatory department include:

  • Cancer centers are delaying nonurgent treatments and using telehealth strategies to decrease hospital and office visits that may pose a risk for patients with COVID-19 infections.
  • Because of the reduction of in-person visits in cancer centers and the increasing needs of all patients, oncology nurses may be asked to work in other units.
  • People with a cancer diagnosis are considered a vulnerable population at risk for more serious consequences if infected with COVID-19.
  • Each nurse’s skills determine the type of reassignments. In preparing for the surge in patients with COVID-19, hospitals are instituting refresher programs for nurses who have not been at the bedside recently.

The assignments may be episodic, and nurses may return to the oncology unit on the same day or for an entire shift. For example, oncology nurses in an outpatient center for infusion therapies or radiation therapy may be assigned to give chemotherapy in the inpatient setting or asked to go to the emergency department to access a port. In either circumstance, oncology nurses floating, briefly or for a shift, to other units with known or suspected COVID-19 infections and returning to the oncology unit put patients with cancer at increased risk.

Decisions about floating staff need to be made with an understanding of the mechanisms of COVID-19 transmission and infection, the higher risks of some patients with cancer (e.g., those receiving cytotoxic chemotherapy, neutropenic patients, blood and marrow transplant recipients, those with leukemias and lymphomas), and the institution’s needs for safe staffing levels.

Appropriate staffing and staff floating contribute to meeting institutional needs and the delivery of safe care that results in optimal patient outcomes. However, developing those protocols during the pandemic requires that decisions be made in the interest of the health of all patients and healthcare staff. 

As nurse leaders face questions in staffing models during the COVID-19 pandemic, ONS recommends:

  • Institutional leadership should identify high-risk populations that are more likely to have serious effects from a COVID-19 infection. Examples include patients with hematologic malignancies, blood and marrow transplants, neutropenia, or treatment with immunosuppressive drugs. ONS recommends that those patients be cared for by designated staff who are not caring for patients with suspected or confirmed COVID-19 infections.
  •  Patients who are COVID-19 positive may be less likely to continue cancer treatments, but if they do, they should be treated in an isolation room and scheduled at the end of the day. Likewise, patients receiving radiation treatments should be scheduled at the end of the day. In both settings, this allows for cleaning the room the per protocol before the next day.
  • Patients with cancer with a known COVID-19 diagnosis should be cared for by a designated cohort of nurses to prevent risk of cross-contamination throughout the nursing staff.
  • Nurses who are caring for patients who are neutropenic should not have contact with patients with suspected or confirmed COVID-19 infection.
  • Policies should be put in place to prevent nurses caring for patients who are neutropenic from floating to areas that have known or suspected cases of COVID-19.
  • For recommendations on return-to-work practices for healthcare staff with confirmed COVID-19 infections, please refer to the CDC website.

Antineoplastics delivered by any route should be administered by RNs who have completed the required training and competency for safe handling and administration of hazardous drugs as identified by institutional policies and procedures.

ONS Recommendations for Oncology Staff Assignments are also available in Spanish.

Updated January 28th, 2021 


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