Volume 21, Issue 1, March 2010
Coordinator's Message

Barbara Biedrzycki, CRNP, AOCNP®
Baltimore, MD

Is it a coincidence that the letters O-N-S appear in the word passions? Our work as nurse practitioners (NPs) often stirs our passions, the fuel that keeps us strong through challenging times and provides elation during the better times.

Our NP-specific passions may be related to our patients, practice, education, legislation, administration, mentoring, regulations, public relations, research, or healthcare reform. They may be focused on individual, institutional, state, regional, or national levels. Identifying our many passions may be easier than prioritizing them. Too many high-priority passions may challenge our ability to fully enjoy the experiences that our passions bring.

I am familiar with the concept of having too many passions because it challenges me often. Here are a few examples of my priority passions. Within my home state of Maryland, we have just introduced HB 319: Nurse Practitioners’ Authority to Practice. This bill will eliminate our mandatory written collaborative agreement with physicians and eliminate the State Board of Physicians’ role in defining our scope of practice. This bill provides us an opportunity to advocate for the passage of the bill, but also we are collecting signatures from the public in support of the bill. While collecting signatures, Maryland NPs are educating Maryland citizens about the education, skills, and practice of NPs. Also, the petition campaign provides a unifying opportunity for several state-wide nursing organizations to work together.

Representatives from a major company have expressed an interest in helping us with our third goal, which is to collaborate with a national organization on a project of mutual interest. Discussions are underway as to how we can work together to advocate for “non-discriminatory” or neutral language in health care and how to promote the role of the oncology NP.

Lastly, an NP SIG member has expressed frustration that NP experience and skills that allow for the prescribing and management of chemotherapy does not satisfy the ONS Chemotherapy and Biotherapy Trainer Course requirement of “two years experience administering chemotherapy within the last five years.” The NP SIG member has past chemotherapy administration experience although not in the past five years and is the most appropriate person in the facility to be the trainer. While acknowledging the value of eligibility criteria, this NP SIG member’s complaint deserves consideration. What are your thoughts on this issue?

The NP SIG has many passions, and I need your help. Join others who share common NP passions. Develop your NP passions into meaningful NP SIG projects that will benefit patients, colleagues, and ONS.

What are your priority passions? Think of how you can work within the NP SIG to ignite yours.
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  March 2010

Editor's Message
Nurse Practitioner Scope of Practice—Are You Paying Attention?

Megan J. Wholey, RNC, ANP-BC, AOCNP®
Arlington, VA

If you attended the ONS Advanced Practice Nursing Conference and our SIG networking meeting in Tampa, FL, last November, you heard some discussion of the American Medical Association (AMA) “Scope of Practice” papers that are being produced regarding practice of what are termed “limited license professionals.” It appears that the purpose of these documents is to maintain physician oversight of all health care, regardless of the setting. While acknowledging the safe, high-quality care delivered by nurse practitioners (NPs), concerns are raised that NPs with doctorates will seek to function as MDs without comparable clinical hours during their training. The issue of specialty certification is raised as an indicator that our profession has gone beyond the bounds of the originally-envisioned primary care force from the 1960s by Loretta Ford and others.

In fact, our oncology experience shows that when a patient population needs access to care, we NPs are providers who can facilitate timely evaluation and treatment. I suspect that oncologists with NP support have a diminished stress level in comparison to their colleagues lacking such support. A friend who recently sought second opinions at two academic institutions was impressed by the team approach in which most of her time was spent with the NP.

The AMA document points out that two different accreditation bodies exist for NPs, with different pass rates on certification examinations. This may be a legitimate case for further evaluation and discussion within our professional organizations. The varied educational preparation of NPs is raised, and the varied practice experience of nurses prior to NP certification is commented on.

My state of Virginia has a proposed bill (SB 263) in the current legislative session that would remove the “physician supervision” requirement currently contained in our practice act. We are currently one of 12 states which includes this regulatory language. Thanks to the efforts in previous years, we currently are able to prescribe U.S. Drug Enforcement Administration schedule II–V drugs while prior to 2003 we were limited to schedule IV and V. Our scope of practice is something we’d like to see under nursing authority. Attention at both the state and national levels is going to be necessary going forward. I urge you to tune in and stay informed—our practice environments may well be affected! Addendum: SB 263 did not make it out of committee this legislative session.  We will, however, be back next year. One lesson learned is the value of constituent communication with legislators.

One of the best features of the NP SIG page on Facebook is the opportunity for networking and interaction. Be sure to join the fanpage on Facebook, and check out the discussion form. Let us know what you’d like to see on our page!

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Special Interest Group Newsletter  March 2010

What Is "PhRMA"?
How Does it Affect Advanced Practice Nursing?

Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Kingsport, TN

We hear the term “PhRMA guidelines” every day, but what does it really mean? How does it affect our advanced nursing practice? Where can I read these guidelines? Who created the guidelines? Are these guidelines legally binding? Like me, you may have asked yourself these questions and probably only when it has interfered with something in our own little world!

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading pharmaceutical research and biotechnology companies. Their Web site is www.phrma.org. Membership may be viewed online and consists of pharmaceutical companies, including international affiliates, researchers, contract research organizations (CRO), advertising and communication services, and consultant firms. This is the “Who’s Who” list, and you may be surprised who is and isn’t listed.

PhRMA's mission is “winning advocacy for public policies that encourage the discovery of life-saving and life-enhancing new medicines for patients by pharmaceutical/biotechnology research companies.” To accomplish this mission, PhRMA proposes broad patient access to medicines through a free market without price controls; strong intellectual property incentives; and transparent, efficient regulation with free flow of information to patients.

PhRMA’s Web site provides quite a bit of interesting information. It addresses four basic areas.

  • Safety
  • Innovation
  • Education
  • Issues

Issues addressed on this Web site include healthcare reform, Medicare, importation of drugs, U.S. Food and Drug Administration (FDA) issues, prescription drug costs, direct-to-consumer advertising, and disaster response, as well as others. You’ll also find a searchable database of medicines currently in clinical trials or at the FDA for review; a searchable list of newly approved medications in the United States; a link to Partnership for Prescription Assistance, an agency that helps patients in finding financial assistance for medications. The Web site also offers numerous publications including reports, profiles, newsletters, testimonials, official submissions, fact sheets, policy papers, media releases, and of course, the infamous PhRMA guidelines.

So, just what are these “PhRMA guidelines?” PhRMA publishes multiple principles and guidelines about clinical trials, direct-to-consumer advertising, health outcomes research, pharmaceutical supply chain, and interactions with healthcare professionals. The “Code on Interactions with Healthcare Professionals” has received the most attention.

The “Code on Interactions with Healthcare Professionals” is a voluntary code describing the relationships between pharmaceutical companies and U.S. healthcare professionals. The most recent version took effect in January 2009. The Code’s purpose is to reinforce PhRMA’s intention that interactions with healthcare professionals are professional exchanges designed to benefit patients and to enhance the practice of medicine. Although these guidelines appear very clear, each pharmaceutical company may interpret them differently, setting their own policies in place with the advice of legal counsel. The PhRMA code is not a law, but a proposed standard of professional behavior. Some states (such as Vermont and Minnesota) do have laws in place that require pharmaceutical companies to publicly disclose how much was given and to whom. Proposed Federal legislation has been presented (such as the Physician Payment Sunshine Act of 2009, SB2029 and HR3138) to require reporting of various payments such as consulting fees, honoraria, grants, and gifts to physicians and physician-owned entities. Both of these bills currently have been referred to committee as of January 2009 and July 2009 respectively.

So what does the Code say are acceptable and unacceptable interactions?

  1. Meals
    1. No, if offered by pharmaceutical company representatives (drug reps) outside of the hospital or office setting. No “take-out” meals or “dine and dash” programs.
    2. Yes, if offered by pharmaceutical company representatives in a hospital or office setting and considered modest and there is presentation of information of educational value. Modest meals also may be provided during speaker programs that are promotional programs and distinct from continuing medical education (CME) programs. May also provide monies to a third-party CME provider, such as scientific or educational conferences or professional meetings that may choose to use monies for meals solely at its discretion.
  2. Gifts
    1. No. No entertainment or recreational items, trips, gift certificates, cash gifts, travel for CME meeting attendance, pens, notepads, mugs, artwork, etc.
    2. Yes. Educational items valued at $100 or less that do not have value to healthcare professionals outside his or her professional responsibilities (such as a text book or anatomical model) and only offered on an occasional basis.
  1. Pharmaceutical Company support of CME
    1. No. Cannot promote a particular medication; cannot pay for costs of travel or other expenses of attendees.
    2. Yes. CME grant-making is permissible but must be separate from sales and marketing departments; Criteria must be in place for making CME grant decisions and all financial support should be given to the CME provider who has total responsibility and control over the education content, faculty, etc. May support third-party scientific and educational conferences or professional meetings and monies are used solely at the discretion of the recipient with no influence from the pharmaceutical company.
  1. Consulting
    1. No. Not to be used as a reward or inducement for prescribing a particular medicine or course of treatment; not to be held at a resort but at a venue conducive to learning environment.
    2. Yes. Decisions regarding selection of consultants should be based on criteria such as medical expertise, knowledge, and experience. Honoraria may be paid based on fair market value as well as travel, lodging, and meals. This must be a bona-fide consulting arrangement including a legitimate need, contract, and record-keeping.
  1. Speaker Programs and Training for Speakers
    1. No. Selection of speakers is not to be used as a reward or inducement for prescribing a particular medicine or course of treatment; training is not to be held at a resort but at a venue conducive to learning.
    2. Yes. Healthcare professionals may receive honoraria for training time, honoraria for speaking (both at fair market value), and reasonable lodging and travel expenses. When speaking for a pharmaceutical company, the speaker should clearly indicate that this is a promotional program, that he or she is receiving an honorarium, and is presenting information consistent with FDA guidelines. Companies should periodically monitor speaker programs for compliance with FDA regulatory requirements.
  1. Healthcare professionals with industry ties as members of committees that set formularies or develop clinical practice guidelines
    1. Yes. However, the speaker or consultant must disclose to the committee the existence and nature of the relationship with the pharmaceutical company recusing themselves from decisions that relate to the medicine for which they have provided speaking or consulting services.
  1. Scholarships or educational funds
    1. No. Cannot be offered in exchange for prescribing products or a commitment to prescribe products.
    2. Yes. For training at carefully selected educational conferences as long as the selection of individuals who receive the funds is made by the academic or training institution. (This includes major national, regional, or specialty scientific, educational, or policy-making meetings.)

Read the full 31-page Code. Pharmaceutical companies who have publically pledged to abide by this Code and who complete an annual certification that they have policies and procedures in place to foster compliance with this code are identified on PhRMA’s public Web site. Check out the list of these companies (updated March 10, 2010).

How does this Code affect advanced practice nursing? Some of us have been prohibited from speaking for pharmaceutical companies by our employers based on their interpretation of this Code (although this is not prohibited by the Code). Some of us live in states that require public reporting of any financial gain (however legitimate) from a pharmaceutical company (this is because of state law not the Code). None of us are recipients of continuing nursing education (CNE) directly from PhRMA (although meetings such as ONS Congress or the Advanced Practice Nursing Conference that offer CNE/CME may be supported by PhRMA). None of us get pens or sticky notes from PhRMA anymore (although we may get a textbook now and then). Breakfasts or lunches still may be offered in workplace settings but should be accompanied by relevant and FDA-approved informational communication.
All nurses, especially advanced practices nurses, should be familiar with the PhRMA Code. We need to understand what voluntary compliance is, as well as what is legally required by the state in which we practice. We, as healthcare professionals, must strive to keep our relationships with PhRMA ethical, keeping in mind that any professional relationship should benefit patients and patient outcomes, enhancing both the practice of nursing and medicine.

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Special Interest Group Newsletter  March 2010

Nurse Practitioner SIG Job Description

Are you looking for an opportunity to be a leader or mentor and share your expertise? Then, the Nurse Practitioner (NP) SIG Job Description Project is for you! Last year, the NP SIG leadership decided to post NP job descriptions on the ONS NP SIG Virtual Community (VC). This will be a resource for all ONS NP, especially those individuals who have just graduated or are starting a new position. The process is simple. Just send in your NP job description with the necessary release form (one for institutional setting or one for personal job description). This will then be added to the NP SIG VC. Being a leader has never been so easy! For further information, please e-mail Diane Cope at dgcope@comcast.net.

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Special Interest Group Newsletter  March 2010

How do You Help Patients With Decision Making and Sustaining Change?

RE:Connect is a blog written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses. This month on RE:Connect, you’ll find discussions about decision making, changes, OCN certification, care for the caregiver, and the work of cancer survivorship. As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

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Special Interest Group Newsletter  March 2010

ONS Article of Interest
Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service takes a look at Nursing Care of Tenckhoff Catheters for Malignant Pleural Effusions, which appeared in the February 2010 issue of the Clinical Journal of Oncology Nursing.

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Special Interest Group Newsletter  March 2010

Breast Cancer Trials

The following is reprinted with permission from BreastCancerTrials.org.

BreastCancerTrials.org is a non-profit service dedicated to providing accurate information about breast cancer clinical trials. Their patient-centered Web site includes trials funded by the National Cancer Institute, public research foundations, and the pharmaceutical/biotechnology industry.

Their goal is to help patients gain insight into the clinical trials process and make it easier and faster for them to find the clinical trials that are right for them. BreastCancerTrials.org accomplishes this by allowing patients to match their histories with current ongoing clinical trials locally and across the country. Please share this Web site with your patients and fellow nurses to help increase awareness of clinical trials.

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Special Interest Group Newsletter  March 2010

Lilly Oncology on Canvas
Expressions of a Cancer Journey

The following is reprinted with permission from Lilly Oncology.

Feel. Create. Share the Hope.
Lilly USA, LLC, and the National Coalition for Cancer Survivorship (NCCS) invite those touched by cancer in the United States and Puerto Rico to submit their entries to the 2010 Oncology on CanvasSM: Expressions of a Cancer Journey Art Competition and Exhibition.

Oncology on Canvas is presented by Lilly in partnership with NCCS, which advocates for quality cancer care for all Americans and provides tools and resources that empower people affected by cancer to advocate for themselves. The biennial competition invites individuals touched by cancer—patients, their families, friends, caregivers, and healthcare providers—to express, through art and narrative, the life-affirming changes that give their cancer journeys meaning.

You don’t have to be a professional artist or writer—it’s the sharing of the journey that counts. By participating in the competition, you can help inspire others along the way. The artwork may be showcased in the finale event and posted on www.LillyOncologyOnCanvas.com. Winners select their favorite cancer charities to receive their prize donations. Following the competition, much of the artwork will embark on a nationwide tour.

Completed entries need to be postmarked by June 30, 2010. To learn more about Lilly Oncology on Canvas, download an entry packet, or register online, please visit us at www.LillyOncologyOnCanvas.com.

You can e-mail us at artdirector@mylooc.com or call 866-991-LOOC (5662). You also can follow us on twitter.

Learn more about NCCS.

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Special Interest Group Newsletter  March 2010

ONS Resources of Interest

Check out ONS Board of Directors President Brenda Nevidjon’s guest commentary on Health Care Changes: How Cancer Care Initiatives Can Help, which appeared in the National Cancer Institute Cancer Bulletin along with an article about EGFR inhibitors that was written with the help of a number of ONS members titled New Cancer Drugs Bring New Side Effects, and Nurses Respond.

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Special Interest Group Newsletter  March 2010

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://ons.org/membership 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
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.
  • Locate and select "Subscribe to Discussion"
  • Enter e-mail address.
  • 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.
  • 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.
  • Select the "Click Here" feature, which will take you to a link to subscribe.
  • Once the "For Announcement Subscription Only" page appears 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."
  • Click "Finish"
  • You are now subscribed to receive announcements.
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Special Interest Group Newsletter  March 2010

Nurse Practitioner SIG Officers

Coordinator (2007–2010)
Barbara Biedrzycki, CRNP, AOCNP®
Baltimore, MD

Megan J. Wholey, RNC, ANP-BC, AOCNP®
Arlington, VA

Web Page Administrator
Jennifer Wulff, RN, MN, ARNP, AOCNP®
Lynwood, WA


Legislative Issues
Wendy H. Vogel, RN, MSN, FNP, AOCNP®
Bristol, TN

Barbara Biedrzycki, CRNP, AOCNP®
Baltimore, MD

ONS Copy Editor
Emily Nalevanko, MFA
Pittsburgh, PA

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 Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership/Leadership Team Contact Information

Brian Theil, Director of Membership

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services

Carol DeMarco, Membership/Leadership Specialist

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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