Preparing Nurses for Advanced Practice in Oncology and Palliative Care

Barbara Daly, PhD, RN, FAAN

Helen Foley, MSN, AOCNS®

There has been much talk in recent years about the lack of conformity in the way advanced practice nurses are educated and licensed. This has led to difficulties for nurses as they change employers or move to new locations, as well as difficulties for organizations in establishing credentialing processes.

In 2008, the national consensus project of the National Council of State Boards of Nursing and 20 nursing specialty groups, including the Oncology Nursing Society, issued a position statement establishing new criteria for the licensing, accreditation, certification, and education of advanced practice nurses known as LACE. This model recognizes four roles for advanced practice registered nurses (APRNs): certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP).

APRNs are educated in one of these four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related, or psych/mental health. Under this model, nurses with more specific clinical specialties, such as oncology, must obtain certification in one of the six focus areas, and then may also seek added certification in the specialty if desired.

In-Depth Preparation for Well-Rounded Care

The process of implementing this model, with accompanying changes in state licensure regulations, has begun in most locations. Many schools of nursing have either dropped their specialty programs or had to revise curricula in order to adequately prepare students for certification. The LACE model will effectively address the need for more consistency in regulation of advanced practice across state boundaries. However, it has the potential to discourage specialty preparation, as schools struggle to avoid extending the length of graduate programs and the associated costs of preparing students in both the general population areas and a specialty. The Frances Payne Bolton (FPB) School of Nursing has developed an innovative, multifaceted graduate program that addresses the new licensure model and the need to prepare students for advanced practice in oncology/palliative care, without extending the length of the program or increasing tuition costs. The program reflects the educational philosophy of the faculty, which includes the following:

• A commitment to in-depth preparation of students for the critical role of the APRN in caring for patients with cancer and other life-limiting illnesses
• A belief that quality cancer care includes expert symptom management
• A view that in today’s often fragmented and overly specialized medical care systems, patients require clinicians who can address all of the most common comorbidities, as well as specific needs related to their cancer diagnoses

Flexible Options to Meet Student Needs

Leading to the Master of Science in Nursing (MSN), the program prepares students to take the adult nurse practitioner certification exam, the advanced oncology exams (AOCNS or AOCNP), or the Hospice and Palliative Care certification exam. In addition to the standard core courses required in all master’s programs (physiology, pharmacology, physical assessment, research, and professional role development), the Adult-Gerontology/Oncology-Palliative Care curriculum includes 750 hours of supervised clinical practice in primary care settings, acute oncology settings, and palliative care or hospice programs. Students are required to integrate their learning of the management of common chronic conditions within their care of patients with cancer. In addition, the commitment to inter-professional learning is implemented through classes with oncology fellows, pastoral care students, and social work graduate students. FPB’s School of Nursing has risen creatively to the challenge of meeting the needs of students who do not live the Cleveland area but wish to pursue a degree in our program. Many of our courses are taught in an intensive format, allowing students to attend a class on site for several days. Some classes are completed this way, in 3-6 days, whereas others are completed online once the student has returned home.

Our more specialized oncology/palliative care classes can be attended via a Web-based program through which the distance student can participate in real time during the class. This allows active participation in small-group work as well as the classroom lecture. Clinical hours can be completed with a local preceptor who works with our faculty to ensure quality experiences in the practice setting. Because most of our students work, our curriculum is flexible, and students can complete it on a full- or part-time basis.

FPB faculty bring research and practice expertise to the classroom—practice expertise in areas such as pain management and palliative care, end-of-life patient and family support, and evidenced-based oncology care enhances the classroom experience, while research expertise in caregiver strain and burden, long-distance caregiving, and inter-professional support for patients and family caregivers has enabled our faculty to make significant contributions in the field of oncology/ palliative care nursing research. We look forward to sharing some of that expertise with you through our collaboration with Oncology Nursing News.