Nurse Practitioner

special interest group newsletter

Volume 24, Issue 1, September 2013
Coordinator’s Corner:
SIG Meeting Planned for Connections Conference

Tamika Turner, MS, NP-C, AOCNP®
Indianapolis, IN

Greetings from your Nurse Practitioner (NP) SIG coordinator! I hope this finds you all well. The ONS Connections conference is coming up in Dallas, TX, beginning November 7. We are planning to hold an NP SIG meeting during that conference; it is scheduled for November 8. Based on feedback from this year’s Congress, we will have a short business meeting and then offer opportunities for networking.

Thanks to those who responded to the inpatient oncology NP survey looking at inpatient staffing ratios and utilization of inpatient NPs. We have analyzed those results, and we will be presenting them at the Connections conference during a poster session. A sampling of the findings is included in “Snapshot: The Role of Inpatient Oncology Nurse Practitioners.

Last but not least—we have a wonderful membership. I am absolutely positive that we have some very creative minds and members with leadership potential. I plead with you to get involved in some way—submitting articles for the newsletter, sending ideas for meeting topics, or making suggestions for the Virtual Community. I know we all have busy lives, but your involvement in and support of the NP SIG is essential to our success.

Please e-mail me your thoughts and concerns.

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

Nurse Practitioner

Special Interest Group Newsletter  September 2013

The LACE Model:
What Does It Mean to Oncology Nursing?

Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Many nurses call themselves advanced practice nurses (APNs). However, because the term “APN” doesn’t have one uniform meaning, consumers are somewhat confused and state boards of nursing have varying and inconsistent rules nationwide; no APN uniformity exists across states. This confusion is not helpful in public policy discussions, particularly as nurse practitioners (NPs) seek increased autonomy and opportunities for reimbursement. The inability to guarantee that a nurse clinician meets a minimal standard of didactic education, specifically in physical assessment, pathophysiology, and pharmacology, or meets a minimal number of precepted clinical hours is viewed as a liability.

Thus, in 2015, the Advanced Practice Registered Nurse (APRN) Consensus Model will be operationalized through the Licensure, Accreditation, Certification, and Education (LACE) Model, a plan to regulate the licensure of APNs in a nationally uniform manner through accreditation, certification, and education (National Council of State Boards of Nursing [NCSBN], 2008). Four APRN roles will be nationally recognized— certified registered nurse anesthetist, certified nurse-midwife, clinical nurse specialist, and certified NP. Education and certification will be according to population focus, rather than disease-specific. Adult NPs will be recognized as acute care or primary care without opportunity for disease-specific certification (American Association of Colleges of Nursing, 2013b). A toolkit with detailed explanations of these changes is available on the NCSBN Web site.

These changes have many NPs worried about optimal preparation for oncology nursing practice. Although predicting where a career will go is difficult, NP students interested in oncology should ask themselves what level of patient acuity they prefer and if inpatient oncology could be an option for their career. If an inpatient role is considered, credentialing may be contingent on acute care NP preparation.

Conversely, acute care NPs working in an outpatient oncology clinic with routine follow-up patients without any inpatient experience may not feel that their acute care education is well suited to that environment. The exact educational level (primary care vs. acute care) that is appropriate for patients with cancer is unknown. It is highly dependent on the students’ preference and comfort level with the type of patient with cancer with whom they are interested in working throughout their career. Questions and answers regarding education, certification, and clinical privileging will evolve throughout the implementation of this model. We, as oncology NPS, need to stay involved and informed.

Another change in NP education and certification is the addition of gerontology to the primary and acute care NP programs (American Association of Colleges of Nursing, 2013a). The NP programs will now be known as Adult-Gerontology Primary Care and Adult-Gerontology/Acute Care. Certification eligibility now will be contingent on applicants completing the NP programs with gerontology content integrated into the curriculum. The implication of this change on those who currently hold certification without the gerontology title is that, if for some reason their certification lapses, the availability of exams without the gerontology title is limited.

The LACE Model does speak to specialty certification. The certification of an NP for a specific disease, such as cancer, is in addition to the population focus certification. Although the designation of an oncology NP cannot be used for state licensure, this specialty certification is strongly encouraged. Because of the shift away from disease-specific programs, the worry is that NPs will have little to no oncology content in their broad-based curriculums. Having the credential of Advanced Oncology Certified NP designates you as someone with guaranteed clinical experience and didactic preparation in oncology. In addition, many states do count specialty certification toward continuing education credits necessary for license renewal.

American Association of Colleges of Nursing. (2013a). Adult-gerontology APRN education project. Retrieved from

American Association of Colleges of Nursing. (2013b). APRN consensus process. Retrieved from

National Council of State Boards of Nursing. (2008). APRN joint dialogue group report. Retrieved from

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

The Role of Inpatient Oncology Nurse Practitioners

Aaron Begue, MS, RN, FNP
Alexandria, OH

Several forces in health care combine to shape the current trend of utilizing nurse practitioners (NPs) in the acute care setting to care for patients with cancer. A real and projected shortage of providers exists for patients who are critically ill. Care needs are particularly great in the acute care setting, where continuous, high-level patient coverage is needed. Physicians “in training,” formerly counted on to staff the inpatient and intensive care units around the clock, now have very stringent guidelines for hours worked, limiting their availability. The pool of highly trained hospitalists or intensive care specialists cannot meet the around-the-clock demands (Gershengorn, Johnson, & Factor, 2012).

The concern that “non-physician providers” would not provide safe or high-quality care in the acute care setting is unfounded. Literature surrounding NP outcomes in the acute care setting is developing. From 2002–2011, several studies were designed comparing inpatient NP outcomes to those of house staff or established teams before and after the addition of NPs (Burns et al., 2003; Gershengorn et al., 2011; Gracias et al., 2008; Hoffman, Miller, Zullo, & Donahoe, 2006; Hoffman, Tasota, Scharfenberg, Zullo, & Donahoe, 2003; Hoffman, Tasota, Zullo, Zcharfenberg, & Donahoe, 2005; Russell, VorderBruegge, & Burns, 2002). The medical outcomes, such as mortality and ventilator weaning success, were not different, but length of stay, cost, iatrogenic infection control, and coordination of care were found to be favorable with the inclusion of acute care or inpatient NPs. No instance of worse outcome was attributed to NPs.

Lastly, re-strategizing oncology care delivery by increasing the numbers and expanding the roles of oncology NPs (ONPs) is considered critically important to meet the current and future cancer care needs in the United States.

These forces combined to create the rapid acceptance and utilization of ONPs throughout the United States. As these numbers grew, ONPs were reported to be managing inpatient services, responsible for large caseloads, coordinating and supervising house staff, working without appropriate collaboration, working long hours, and having few days off. A snapshot of current inpatient ONP practice was sought in order to establish benchmarks for safety and quality of NPs within this setting. This project, conducted through the NP SIG, sought to provide baseline data regarding the demographics, workload, and responsibilities of this unique cancer care provider. An electronic survey was developed by members of the NP SIG and distributed to SIG members.

A total of 1,965 questionnaires were distributed to NP SIG members. One hundred and twelve people responded for a 5.7% response rate. The majority (n = 25) of the respondents were between 50–54 years of age. Eighty-six percent (n = 96) were master’s-prepared, and 8% (n = 9) were doctorally prepared. The mean years of nursing experience was 20.4 years, with 6.7 years of NP experience and 6 years of ONP experience. Half ( n = 56) of the respondents identified the practice setting as “academic,” and 25% (n = 28) identified it as “private practice” or “other.” Salaries were reflective of national NP salaries. Sixty percent (n = 68) of the ONPs made $90,000 or more annually, including the 40% (n = 45) of the respondents who made more than $100,000 annually.

Practice issues were explored, and attempts were made to better define the expectations of the role of NPs working in oncology on an inpatient unit. Forty-one percent (n = 46) of the respondents rounded on 5–9 patients daily, with 12.5% (n = 14) rounding on more than 20 patients daily. ONPs largely (88%, n = 98) could not personally “cap” admissions, but 49% (n = 55) of the respondents felt they could provide safe and quality care for 5–9 patients. The mean number of times that activities were performed during a typical month was estimated as follows: rounding with physicians (32 times per month), patient and family teaching (31 times per month), discharge planning (20 times per month), medical management other than oncology (19 times per month), and coordination of care (18 times per month). Procedures were not a large part of daily responsibilities.

This role will require greater exploration. Although broad in scope, these data begin to paint a picture of ONP daily life. Patient-centered outcomes will need to be incorporated into measures of quality for inpatient ONPs. Safety and quality issues, such as limits to patient numbers, admissions, procedures, and collaboration with medicine, should be further evaluated. Future studies should result in a better understanding of ONP demographics, practice issues, and, most importantly, patient outcomes.

Burns, S.M., Earven, S., Fisher, C., Lewis, R., Merrell, P., Schubart, J.R., . . . University of Virginia Long Term Mechanical Ventilation Team. (2003). Implementation of an institutional program to improve clinical and financial outcomes of mechanically ventilated patients: One-year outcomes and lessons learned. Critical Care Medicine, 31(12), 2752-2763.

Gershengorn, H.B., Johnson, M.P., & Factor, P. (2012). The use of nonphysician providers in adult intensive care units. American Journal of Respiratory and Critical Care Medicine, 185(6), 600-605.

Gershengorn, H.B., Wunsch, H., Wahab, R., Leaf, D.E., Brodie, D., Li, G., & Factor, P. (2011). Impact of nonphysician staffing on outcomes in a medical ICU. Chest, 139(6), 1347-1353.

Gracias, V.H., Sicoutris, C.P., Stawicki, S.P., Meredith, D.M., Horan, A.D., Gupta, R., . . . Schwab, C.W. (2008). Critical care nurse practitioners improve compliance with clinical practice guidelines in “semiclosed” surgical intensive care unit. Journal of Nursing Care Quality, 23(4), 338-344.

Hoffman, L.A., Miller, T.H., Zullo, T.G., & Donahoe, M.P. (2006). Comparison of 2 models for managing tracheotomized patients in a subacute medical intensive care unit. Respiratory Care, 51(11), 1230-1236.

Hoffman, L.A., Tasota, F.J., Scharfenberg, C., Zullo, T.G., & Donahoe, M.P. (2003). Management of patients in the intensive care unit: Comparison via work sampling analysis of an acute care nurse practitioner and physicians in training. American Journal of Critical Care, 12(5), 436-443.

Hoffman, L.A., Tasota, F.J., Zullo, T.G., Zcharfenberg, C., & Donahoe, M.P. (2005). Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. American Journal of Critical Care, 14(2), 121-130.

Russell, D., VorderBruegge, M., & Burns, S.M. (2002). Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners. American Journal of Critical Care, 11(4), 353-362.

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Spotlight on Symposia:
Access Supplemental Content Anywhere!

The Spotlight on Symposia, the annual ONS Connect supplement, is now available for free online. This valuable resource features summaries from 12 symposia presented at the Oncology Nursing Society’s 38th Annual Congress in April 2013. Contents cover hematologic malignancies, safety, site-specific cancers, and supportive care. The supplement is easier to access than ever on your tablet, smartphone, or other portable device. Available for free to ONS members and nonmembers alike, check out the Spotlight on Symposia today. Happy reading!

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Exclusive Articles Available Before Print

The Oncology Nursing Forum (ONF) and the Clinical Journal of Oncology Nursing (CJON) now provide advanced print exclusive articles to give our readers access to important, cutting-edge content ahead of print. For a period of time (at least a month) before a new issue of ONF or CJON is released, one article or more from the upcoming issue is made available on the main ONF and CJON pages. These articles are open access, meaning they are available to members and non-members alike, until they appear in print at a later date. At that time, the content will become password-protected like other articles that appear in print as online exclusives in the journals.

The latest article to receive the advanced print exclusive designation is “Multidimensional Needs of Caregivers for Patients With Cancer” by Karen A. Skalla, Ellen M. Lavoi Smith, Zhongze Li, and Charlene Gates. In this CJON article, the multidimensional needs of caregivers of cancer survivors are described. Check out this timely and informative article today.

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Journals Available in Digital Format

Did you know that the Clinical Journal of Oncology Nursing (CJON) and Oncology Nursing Forum (ONF) are available in digital format? To access the digital editions, click on the journal you wish to view at and follow the instructions featured prominently in the top center of the page. The digital editions are a members-only benefit, so make sure you have your ONS username and password handy.

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Check out the ONS Connect Blog

The official blog of ONS is written by oncology nurses for oncology nurses on a variety of topics of interest, 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, you’ll find the following new discussions.

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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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service explains how Cultural Barriers Keep African Americans From Using Palliative Care.

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Ask a Team Member

In the latest issue of ONS Connect, the Ask a Team Member column answers the question What Is the CYP3A Drug-Metabolizing Pathway and How Does it Affect Chemotherapy Levels?

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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Membership Information

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Join a Virtual Community

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Participate in Your SIG’s Virtual Community Discussion Forum

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Sign Up to Receive Your SIG’s Virtual Community Announcements
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Nurse Practitioner

Special Interest Group Newsletter  September 2013

Nurse Practitioner SIG Officers

Coordinator (2012-2014)
Tamika Turner, MS, NP-C, AOCNP®
Indianapolis, IN

Ex-Officio (2012-2013)
Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Margaret (Peg) Rosenzweig, PhD, FNP-BC, AOCNP®
Sewickley, PA

Web Page Administrator
Barbara Biedrzycki, RN, MSN, CRNP, AOCNP®


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

Barbara Biedrzycki, RN, MSN, CRNP, AOCNP®

ONS Copy Editor
Jessica Moore, BA, BS
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 or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership & Component Relations Department Contact Information

Brian K. Theil, CAE, Director of Membership and Component Relations Department

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

Carol DeMarco, Membership Specialist—SIGs

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
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