Volume 16, Issue 3, December 2005
The Nurse Practitioner SIG Newsletter is underwritten through a grant from Amgen Inc.
Coordinator’s Corner
Your Input and Involvement Are Needed

Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN

Hello, and Happy New Year! I hope this communiqué finds you well and happy.

I would encourage you all to keep up with the information about the proposed doctorate of nursing science. I will try to update the reference list every few months. It is posted on our Web site at http://nursepractition.ons.wego.net. The ONS Board of Directors will be meeting in January and will consider the request of a position statement or white paper on the issue. Barbara Gobel, RN, MS, AOCN®, the CNS SIG coordinator, and I worked together to make this request.

Two professional organizations have made statements against the proposal: the American College of Nurse-Midwives Division of Accreditation and the program directors of eleven nurse anesthesia educational programs of the New England Assembly of School Faculty.

A recent article in the Journal for Nurse Practitioners (Vol. 1, No. 4) by Joan Stanley, PhD, CRNP, FAAN, the director of education policy for the American Association of Critical Care Nurses (AACN) in Washington, DC, attempts to clarify some of the key issues surrounding the AACN's position statement. Stanley denies that the AACN meant that all current advanced practice nurses (APNs) must return to school to obtain an additional degree but states that the recommendation is that a transition period be planned and that a mechanism to earn a practice doctorate be provided, giving credit for previous graduate study and practice experience. However, Stanley acknowledges that if master's prepared nurse practitioners (NPs) decide to return for the doctoral degree, each individual school has the prerogative to offer credit for previous experience. She further states that the intent of the position is that NPs currently practicing be grandfathered into their positions and scope of practice as happened with certificate-prepared NPs included in Medicare reimbursement regulations and in criteria for maintaining national certification in all specialty practice areas. Remember, though, when reading this article, that the law at that time changed and now requires a master's degree in nursing to bill and be reimbursed by Medicare. The expectation is that something similar will occur with the proposed changes. The bottom line is that NPs should keep alert and not give up expressing their opinions and thoughts on this subject. Your career and our profession are at stake. If you have not done so already, please e-mail your thoughts on the issue to AACN at DNPfeedback@aacn.nche.edu.

I also would like to take this opportunity to recognize several of our own members who have achieved some milestones in their careers during the past year. Having a member of the SIG honored by ONS is wonderful. Don't forget to nominate your colleagues or yourself for these awards and to apply for grants and scholarships. Congratulations to the following people for their achievements, and please forgive me if I have inadvertently left out someone.

  • Janet Van Cleave, RN, MSN, ACNP-CS, AOCN®: Doctoral student scholarship
  • Marilyn Kile, RN, MSN, CS, AOCN®, APRN: ONS Foundation Practice Change Research Grant
  • Pamela Viale, RN, MS, CS, ANP, OCN®: Susan Baird Excellence in Writing Award in Clinical Practice
  • Marillyn Haas, PhD, RN, CNS, ANP-C: Connie Henke Yarbro Excellence in Cancer Nursing Mentorship Award
  • Agnes Masey, RN, MPH, MSN: Mary Nowotny Excellence in Cancer Nursing Management Award

I look forward to seeing you at Congress in Boston, MA, May 4-7 this year.

The Nurse Practitioner SIG Newsletter is produced by members of the
Nurse Practitioner SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  December 2005

Heed This Advice When Moving from Generalist to Specialist Practice

Kathy Sharp, MSN, APRN-BC, AOCNP
Bristol, TN

An old proverb says, "Nothing is constant except change."

During my first semester of master's degree study, I remember being required to read about and discuss generalist versus specialist practice. At the time, I was preparing for a clinical specialist role (family nurse practitioner [NP] study came later) and did not understand the significance of the "leap of faith" that I would need to take later in my career. Two years ago, I anticipated that I would retire from the family practice office where I was employed. However, a change in the ownership of my practice site and the absence of a contract left me with only six weeks notice to find a new job. I found myself facing a plethora of specialty job interviews because no family practice jobs were available. My perspective of the future suddenly took on an uncertainty, which was uncomfortable and filled me with trepidation.

Healthcare is undergoing constant change, and the role of the NP constantly evolves. Although the role actually began within a specialty (pediatrics), it quickly evolved into a more generalist role (family practice). The pendulum now has swung back toward specialty practice, with 59% of NPs in a specialty other than family practice (American Academy of Nurse Practitioners, 2005).

Educational programs have been created, expanded, and changed to address the needs of specialty practice, but little has been written regarding the steps to a successful transition from generalist to specialty practice. I would like to offer some tips for making that transition easier for those who are moving toward specialty areas of practice.

Embrace change: This adage is used often but, in order to make the change positive instead of negative, must be embraced like an old friend. None of us likes to shed the comfortable cloak of familiar surroundings or work habits, but, as I have learned, change forces us out of our complacency.

Educate yourself: Most people go into a specialty because they have some interest in it. In my case, I was not interested in oncology; however, God seemed to have laid out that path for me to follow because every other job lead had been a dead end. I now realize that oncology was where I needed to be, and I find that it affords me the opportunity to use all of my talents. Educational preparation for me came in the form of a very timely one-week oncology course and a two-day chemotherapy class, both of which were paid for by my new employer. Now that specialty practice has seemed to explode, textbooks about almost every specialty are available. If not, self-study courses through specialty organizations can provide preliminary preparation for on-the-job training. For NPs going into oncology, the annual ONS Congress and Institutes of Learning provide a wealth of opportunities for education. The American Society of Clinical Oncology also holds an annual conference in addition to offering continuing education for purchase online. Those in all specialties can find information and continuing education at www.medscape.com, and can choose "Homepage Set-Up" to continue receiving specialty-specific information each time Medscape is accessed (Medscape, 2005; Oncology Nursing Society, 2005).

Elicit a mentor: In my case, I shared an office with a friend who is an experienced certified oncology NP. No situation could be better than that! If you don't have that kind of opportunity, find a mentor in your specialty that can guide, advise, recommend, and support your transition. Even if your mentor is not on site, having someone to call with questions is invaluable. ONS has a mentoring program established to match inexperienced nurses with experienced mentors. The Nurse Practitioner (NP) SIG also has a mentoring program available. (For more information, see the "Coordinator's Corner" article in this newsletter.) Many other specialty organizations also sponsor mentoring programs, and information is available on each of their Web sites (Oncology Nursing Society, 2005).

Empower yourself with patience: Give yourself time to learn and become proficient in your new role. Moving from being a confident and independent family NP to a specialty where I was uncertain was quite unnerving at first, and I did not allow myself the luxury of some self-indulgence. I was frustrated at what I did not know instead of being confident in the learning process and tolerant of my position on the learning curve. As nurses, we all seem to have tendencies to be impatient with ourselves. Avoid that mistake. Whether you simply are changing jobs or making the move to specialty practice, remember to have confidence in yourself and your choices. That confidence will allow you to reach your career goals, regardless of where they lead!

American Academy of Nurse Practitioners. (2005). NP demographics. Accessed May 9, 2005, from http://www.aanp.org/About+AANP/Marketing+and+PR/NP+Demographics.html

Medscape. (2005). Hematology-oncology CME Center. Accessed May 9, 2005, from http://www.medscape.com/cmecenterdirectory/oncology?src=hdr

Oncology Nursing Society. (2005). ONS advanced practice nurse virtual community. Accessed May 9, 2005, from http://apn.ons.wego.net/index.v3page?v2_group=0&p=160

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Special Interest Group Newsletter  December 2005

Is Vitamin E Safe?

Wendy H. Vogel, MSN, FNP, AOCN®
Bristol, TN

Have any of your patients asked you about vitamin E lately? Many of our patients take vitamin E supplements-some because of our own advice. Recently, however, results from a clinical trial were publicized that question the safety of vitamin E. So what is the "rest of the story"?

Vitamin E has been touted as beneficial for treating many diseases and symptoms such as Alzheimer's disease and cardiovascular disease, preventing morbidity and mortality in preterm infants, reducing upper respiratory tract infections, for intermittent claudication, suppressing latent HIV activation, decreasing cancer risk, and reducing hot flashes, just to name a few. Observational evidence exists that vitamin E supplementation is associated with a decreased risk for cardiovascular disease (Schwenk, 2005). The rationale for this belief is that oxidation of low-density lipoprotein and certain other cellular targets may contribute significantly to atherogenesis and carcinogenesis. So, seemingly, then, antioxidants should protect against atherosclerosis by limiting low-density lipoprotein oxidation in the arterial wall (Lonn et al., 2005). However, in a recent clinical trial published by JAMA, long-term vitamin E supplementation was not found to prevent cancer or major cardiovascular events and may even increase the risk for heart failure.

The objective of the clinical trial was to evaluate whether long-term supplementation of vitamin E decreases the risk of cancer, cancer death, and major cardiovascular events. The initial Heart Outcomes Prevention Evaluation (HOPE) trial that was conducted from 1993-1999 was extended and called HOPE—The Ongoing Outcomes (HOPE-TOO), which compiled data from 1999-2003. Participants in the trial were at least 55 years of age and had been diagnosed with vascular disease or diabetes mellitus. They were given a daily dose (400 IU) of natural source vitamin E (n = 552) or a placebo (n = 586). The investigators of HOPE-TOO found no significant difference in cancer incidence, cancer deaths, or major cardiovascular events. However, researchers found higher rates of heart failure and hospitalizations for heart failure in the group taking vitamin E.

Another recent meta-analysis of high-dose vitamin E supplementation was published in the Annals of Internal Medicine (Miller et al., 2005). The conclusion of this trial was that high-dose (> 400 IU per day) vitamin E supplementation may increase all-cause mortality and should be avoided. However, many of the trials analyzed were small and were performed in patients with chronic diseases so that the generalizability of these findings to healthy adults is unclear.

So, what should we do? Some studies have concluded that vitamin E supplementation should be avoided in patients with cardiovascular disease or diabetes mellitus to eliminate the potential for harm (Karpman, 2005). But the benefits may outweigh the potential risks of vitamin E supplementation in some cases. For example, healthy evidence exists that vitamin E plus zinc delays the progression of age-related macular degeneration (Age-Related Eye Disease Study Research Group, 2001). So, each patient should be treated as an individual and recommendations should be based on his or her own health history and individual benefits versus risks.

Age-Related Eye Disease Study Research Group. (2001). A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Archives of Ophthalmology, 119, 1417–1436.

Karpman, H. (2005). Vitamin E—Good or bad? Internal Medicine Alert, 27, 65–66.

Lonn, E., Bosch, J., Yusuf, S., Sheridan, P., Pogue, J., Arnold, J.M., et al. (2005). Effects of long-term vitamin E supplementation on cardiovascular events and cancer: A randomized controlled trial. JAMA, 293, 1338–1347.

Miller, E.R., III, Pastor-Barriuso, R., Dalal, D., Riemersma, R.A., Appel, L.J., & Guallar, E. (2005). Meta-analysis: High-dosage vitamin E supplementation may increase all-cause mortality. Annals of Internal Medicine, 142, 37–46.

Schwenk, T.L. (2005). Vitamin E supplementation: What to do? Retrieved December 5, 2005, from http://general-medicine.jwatch.org/cgi/content/full/2005/329/1

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Special Interest Group Newsletter  December 2005

Take Advantage of These Opportunities from ONS

ONS Foundation Research Grant-Writing Education Mentorship Program
The ONS Foundation Research Grant-Writing Education Mentorship Program provides grant-writing education and guidance to master's prepared nurses who have an idea for a research project that they want to develop and implement. Four participants will work with a coach who will guide them through writing a research proposal, developing a research team, submitting an ONS Foundation Small Grants Program application, and the initial phases of conducting the research. This program is supported through an education grant from Sanofi-Aventis. The program will be held in Pittsburgh, PA, in March 2006.

Eligibility: Master's prepared nurses who are not enrolled in a doctoral program, have an idea for a research project, and submit a program application are eligible.

Application Due Date: The two-page application, CV, and letter of support from the applicant's supervisor are required by January 17, 2006.

Download Application (Word)
Download Application (PDF)

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Special Interest Group Newsletter  December 2005
News From National

Order the New Chemotherapy Guidelines
Order a copy of the newly revised and updated second edition of your primary resource for chemotherapy administration. With more than 46,000 copies sold since 2001, you and thousands of your colleagues in oncology nursing have studied and consulted the information found in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. The new second edition is on sale now at http://esource.ons.org/ProductDetails.aspx?sku=INPU0560.

Get Your Copy of Nutritional Issues in Cancer Care
Nutritional Issues in Cancer Care, authored by registered nurses and registered dietitians, is a new, practical guide on nutrition for healthcare professionals involved in the day-to-day management of patients in all phases of cancer care, including prevention, treatment, survivorship, and palliative care. Copies are available now at http://esource.ons.org/ProductDetails.aspx?sku=INPU0564.

Check out the Redesigned Evidence-Based Practice Resource Area
Use the Evidence-Based Practice Resource Area as your guide to identify, critically appraise, and use evidence to solve clinical problems. Be sure to check out the new format, which allows for much easier use and navigation, at http://onsopcontent.ons.org/toolkits/evidence/index.shtml.

Check Out Academic Scholarships Offered By the ONS Foundation
Supporting continuing education for oncology nurses has been an integral part of the ONS mission to promote excellence in oncology nursing and quality cancer care. Since 1982, the ONS Foundation has distributed more than $16 million to support the ONS mission. The ONS Foundation continues to support academic scholarships at the bachelor’s, master’s, and doctoral levels of study. To apply for these scholarships, go to www.ons.org.

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Special Interest Group Newsletter  December 2005

Become Familiar With the New Medicare Prescription Drug Plans

All nurses and any staff who have contact with Medicare beneficiaries should be familiar with the Medicare prescription drug plans that will be available in 2006. The important thing to remember is that there will be drug coverage that will help all people who get Medicare pay for their prescriptions—brand name as well as generics®and is available for those who need it. More information on provider education and outreach regarding drug coverage can be found at www.cms.hhs.gov. The information contained in this article is based on a fact sheet for beneficiaries. To obtain a copy of this fact sheet for your patients, visit www.medicare.com. In addition, you can find additional information regarding prescription drug plans at www.cms.hhs.gov. Further information on CMS implementation of the MMA can be found at the CMS web site at www.cms.hhs.gov. Patients can get more information at 1-800-MEDICARE and www.medicare.gov.

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Special Interest Group Newsletter  December 2005

Membership Information

SIG Membership Benefits

  • Network with colleagues in an identified subspecialty area around the country.
  • Contribute articles for your SIG’s newsletter.
  • Participate in discussions with other SIG members.
  • Contribute to the future path of the SIG.
  • Share your expertise.
  • Support and/or mentor a colleague.
  • Receive information about the latest advancements in treatments, clinical trials, etc.
  • Participate in ONS leadership by running for SIG coordinator-elect or join SIG work groups.
  • Acquire information with a click of a mouse at http://sig.ons.wego.net/index.v3page;jsessionid=l5nhe8e4qt77?v2_group=0&p=4918, including
    • Educational opportunities for your subspecialty
    • Education material on practice
    • Calls to action
    • News impacting or affecting your specific SIG
    • Newsletters
    • Communiqués
    • Meeting minutes.
Join a Virtual Community

A great way to stay connected to your SIG is to join its Virtual Community. It’s easy to do so. All you will need to do is
  • Log on to the ONS Web site (http://www.ons.org/).
  • Select “Membership” from the tabs above.
  • Then, click on “ONS Chapters and Special Interest Groups.”
  • Scroll down to “Visit the ONS Special Interest Groups (SIG) Virtual Community” and click.
  • Now, select “Find a SIG.”
  • Locate and click on the name of your SIG from the list of all ONS SIGs displayed.
  • Once the front page of your SIG's Virtual Community appears on screen, select “New User” from the top left. (This allows you to create log-in credentials.)
  • Type the required information into the text fields as prompted.
  • Click “Join Group” (at the bottom right of the text fields) when done.

    Special Notices
    • If you already have log-in credentials generated from the ONS Web site, use this information instead of attempting to generate new information.
    • If you created log-in credentials for the ONS Web site and wish to have different log-in information, you will not be able to use the same e-mail address to generate your new credentials. Instead, use an alternate e-mail address.
Subscribe to Your SIG’s Virtual Community Discussion Forum

All members are encouraged to participate in their SIG’s discussion forum. This area affords the opportunity for exchange of information between members and nonmembers on topics specific to all oncology subspecialties. Once you have your log-in credentials, you are ready to subscribe to your SIG’s Virtual Community discussion forum. To do so,
  • Select “Log In,” located next to “New User,” and enter your information.
  • Next, click on the “Discussion” tab on the top right of the title bar.
  • Now, select “Featured Discussion” from the left drop-down menu.
  • Locate and select “Subscribe to Discussion” inside the “Featured Discussion” section.
  • Go to “Subscription Options” and select “Options.”
  • When you have selected and entered all required criteria, you will receive a confirmation message.
  • Click “Finish.”
  • You are now ready to begin participating in your SIG’s discussion forum.
Participate in Your SIG’s Virtual Community Discussion Forum
  • First, log in. (This allows others to identify you and enables you to receive notification [via e-mail] each time a response or new topic is posted.)
  • Click on “Discussion” from the top title bar.
  • Select “Featured Discussion” from the left drop-down menu.
  • Click on any posted topic to view contents and post responses.
Sign Up to Receive Your SIG’s Virtual Community Announcements

As an added feature, members also are able to register to receive their SIG’s announcements by e-mail.
  • From your SIG’s Virtual Community page, locate the “Sign Up Here to Receive Your SIG’s Announcements” section. This appears above the posted announcements section.
  • Select the “Click Here” feature, which will take you to a link to subscribe.
  • Once the “For Announcement Subscription Only” page appears on screen, select how you wish to receive your announcements.
    • As individual e-mails each time a new announcement is posted
    • One e-mail per day comprised of all new daily announcements posted
    • Opt-out, indicating that you will frequently browse your SIG’s Virtual Community page for new postings
  • Enter your e-mail address.
  • Click on “Next Page.”
  • Because you have already joined your SIG’s Virtual Community, you will receive a security prompt with your registered user name already listed. Enter your password at this prompt and click “Finish.”
  • This will bring up a listing of your SIG’s posted announcements. Click on “My SIG’s Page” to view all postings in their entirety or to conclude the registration process and begin browsing.
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Special Interest Group Newsletter  December 2005

Nurse Practitioner SIG Officers

Coordinator (2005-2007)
Wendy Vogel, RN, MSN, FNP, AOCN®
405 Pettyjohn Rd.
Kingsport, TN 37664-4716
423-323-0715 (H)
423-968-2311 (O)

Ex-Officio (2005-2006)
Diane Cope PhD, ARNP-BC, AOCN®
605 Astarias Circle
Fort Myers, FL 33919-3247
239-437-3571 (H)
239-437-4444 (O)

Barbara Biedrzycki, RN, MSN, AOCN®, CRNP
709 W. Baker Ave.
Abingdon, MD 21009-1457
410-538-7946 (H)
410-614-6894 (O)

Deborah Heim, RN, MSN, BC, AOCN®
5150 Harborage Dr.
Fort Myers, FL 33908-45
42 239-466-4990 (H)
239-437-4444 (O)

ONS Publishing Division Staff
Jacqueline Moore, BA
Copy Editor

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Administrative Assistant Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

To view past newsletters click here.

Insert SIG Mission Statement here, if any. If the SIG doesn't have a mission statement, delete this text.

ONS Membership/Leadership Team Contact Information

Angie Stengel, Director of Membership/Leadership

Diane Scheuring, Manager of Member Services

Carol DeMarco, Membership/Leadership Administrative Assistant

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
125 Enterprise Dr.
Pittsburgh, PA 15275-1214

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