Oncology clinical nurse specialist

ALSO KNOWN AS: Oncology nurse specialist, cancer nurse specialist, advanced practice oncology nurse specialist

DEFINITION: An oncology clinical nurse specialist is a registered nurse with a master’s degree and extensive training to provide specialized consultation and care for cancer patients and families.

Subspecialties: The oncology nurse clinical specialist may choose to specialize in a particular cancer practice working with a selected population of patients. Examples of specialties include medical hematology oncology, hematology oncology, outpatient radiation, outpatient hematology oncology, outpatient pediatric oncology, and palliative care.

Cancers treated: Depends on area of specialty

Training and certification: The oncology clinical nurse specialist completes a bachelor’s and master’s degree in nursing with an appropriate clinical practicum from an accredited graduate nursing program. Education programs vary, but master’s degrees generally take about two years to complete, with at least five hundred hours of clinical practicum. Required courses vary but may include advanced physiology and cancer pathophysiology, pharmacology, cancer genomics, epidemiology, disease and symptom management, palliative care, nursing research, nursing and medical ethics, public policy, leadership, healthcare financing, health program planning and evaluation, technology use, and advanced nursing concepts. Practicum hours are usually accrued in the nurse’s chosen specialty.

Additional training and skills necessary to effectively practice as an oncology clinical nurse specialist include crisis management, in-depth knowledge of the chosen clinical cancer specialty, maturity in taking responsibility for patients’ lives, understanding of medical ethics, teaching proficiency, and expertise in interpersonal relations to work with the patient, caregivers, and multidisciplinary healthcare team. Oncology clinical nurse specialists must have valid nursing licenses issued by the boards of nursing in their states.

In some states, oncology clinical nurse specialists must also receive certification by completing examinations in their specialty. In other states, attaining certification status is voluntary. Proficiency is validated through examination based on predetermined standards and given by a nongovernment agency. The Oncology Nursing Certification Corporation provides several certifications for nurses working with cancer patients. The Advanced Oncology Certified Clinical Nurse Specialist (AOCNS) certification examination is available to professional nurses who hold an active, nonrestricted license, have completed a master’s degree or higher from an accredited school of nursing, and have completed a minimum of five hundred hours of supervised clinical practice in oncology nursing. Documentation of the supervised clinical practicum hours is required and verified before certification is granted. AOCNS certification is valid for four years. The AOCNS nurse can renew certification in three ways—combining practice hours and professional development points, combining practice hours and a successful test result, or combining professional development points and a successful test result.

Services and procedures performed: Oncology clinical nurse specialists can work in various settings, including hospitals (acute care), clinics, long-term care or older adult care homes, home care or hospice agencies, private and joint practices, or as consultants. These specialists recognize cancer care's expanding and evolving nature and remain current with complex services, procedures, and treatments. The services and procedures performed depend on the setting and function of the nurse’s specific role.

Some oncology clinical nurse specialists work as clinicians and provide direct care for patients and caregivers. They often work with physicians, nurses, and therapists to plan and evaluate patient care. These nurse specialists schedule and coordinate diagnostic and therapeutic procedures or tests for oncology patients. They monitor the test results and revise patient care plans based on individual and evolving needs. The oncology clinical nurse specialist may perform the initial admission assessment for new patients and develop the care plan at a cancer care clinic or oncology hospital unit. This nurse will monitor the care plan and make adjustments as indicated for the individual cancer patient. The nurse assists with discharge planning, including referrals for other community resources or establishing follow-up appointments at physicians’ offices or cancer care clinics.

Oncology clinical nurse specialists often function as teachers. These nurses keep abreast of current research and therapies in clinical settings. They use their expanded knowledge to teach staff and multidisciplinary healthcare planning team members new concepts or treatment modalities. In the hospital cancer unit or cancer care clinic, oncology clinical nurse specialists help assess staff education, develop educational strategies, coordinate educational agendas, and revise teaching programs. Academic programs are provided as in-service programs or as clinical practicums. They serve as advisers to staff and other professionals. This education aims to organize and implement an educational strategy that trains professional caregivers to provide the best possible cancer care for patients and their caregivers.

Cancer care education is critical for the cancer patient, family, and caregivers to live life fully. The oncology clinical nurse specialist builds relationships with the cancer patient and caregivers and provides individualized patient teaching. Cancer patients need accurate and up-to-date information about their disease and treatment options to make decisions about their care. The highly educated and informed oncology clinical nurse specialist often spends time with the patient and family, teaching them the necessary components of self-care and disease management. Even after discharge from the hospital, the patient and caregivers may contact the oncology clinical nurse specialist with questions and concerns. The positive relationship developed during hospitalization often carries over to the home setting as the oncology clinical nurse specialist fills the role of consultant and educator.

Administrative functions are sometimes part of the services delivered by oncology clinical nurse specialists. They monitor the medication regimen of the cancer patient and suggest changes when needed for improved patient outcomes. Sometimes, they manage the research protocol as primary investigators for grants and clinical studies. Oncology clinical nurse specialists are stewards in the fiscal management of resources by monitoring cancer care costs and noting where services can be delivered more efficiently.

Related specialties and subspecialties:  Oncology clinical nurse specialists can work in several subspecialties depending on their interests and the positions available in the nurses’ area. Roles are evolving and diverse, as the oncology nurse clinical specialist contributes many skills to the healthcare team. Some assume administrative roles and perform at high levels of leadership. For example, oncology clinical nurse specialists may manage specialized hospital oncology units, direct community cancer care centers, become healthcare administrators for managed care or insurance companies, or consult with key decision-makers about covered patient services.

Oncology clinical nurse specialists can pursue further education and receive a doctorate in various academic fields, like cancer research. Another nurse might earn a doctorate in nursing science or a doctorate in education and join a university graduate faculty to teach others to become oncology clinical nurse specialists. As faculty, these nurses mentor undergraduate nursing students to help them become proficient in cancer care. Some pursue additional education to become oncology clinical nurse specialists and practitioners. Still others assume an entrepreneurial spirit and use their knowledge and skills in creative and innovative private and joint practice.

Bibliography

Blaseg, Karyl D., et al. Oncology Nurse Navigation: Delivering Patient-Centered Care across the Continuum. 2nd ed., Oncology Nursing Society, 2020.

Camp-Sorrell, Dawn, and Rebecca A. Hawkins. Clinical Manual for the Oncology Advanced Practice Nurse. 4th ed., Oncology Nursing Society, 2022.

Inumerables, Faye, et al. “Oncology Clinical Nurse Specialists Practice in the Outpatient Setting.” Clinical Nurse Specialist CNS, vol. 38, no. 2, 2024, pp. 98-102. doi:10.1097/NUR.0000000000000808.

Kapra, Ori, et al. “The Oncology Clinical Nurse Specialist: A Rapid Review of Implementation Models and Barriers around the World.” Current Oncology (Toronto, Ont.), vol. 30, no. 8, pp. 7425-7438. 5 Aug. 2023, doi:10.3390/curroncol30080538.

Kerr, Helen, and Johan De Munter. The Role of the Clinical Nurse Specialist in Cancer Care. John Wiley & Sons, 2024. 

"Oncology Clinical Nurse Specialist Competencies." Oncology Nursing Society, www.ons.org/oncology-clinical-nurse-specialist-competencies. Accessed 20 July 2024.

Yarbro, Connie Henke, et al. Cancer Nursing: Principles and Practice. 8th ed. Jones, 2018.

Yarbro, Connie Henke, et al. Oncology Nursing Review. 6th ed., Jones, 2020.