The intent of this position statement is to reaffirm the role of Registered Professional Nurses (RNs) in the evolving care of the individuals, families, and groups at risk for, or with, a diagnosis of cancer, and addressing the effects of the treatment sequelae on long-term survivorship.
It is the position of the New York State Nurses Association that:
The transformation from intravenous administration of chemotherapeutics to nurses caring for a multifaceted population has expanded into the unique and evolving specialty area of oncology nursing. “Cancer is the second leading cause of death in the US, exceeded only by heart disease…[and] the 5-year relative survival rate for all cancers diagnosed between 1995 and 2000 is 64%” (Cancer facts & figures, 2005, p. 2) The impact of the extent of cancer and its sequelae, has penetrated multiple levels of nursing throughout the healthcare spectrum. Nurses are experiencing an increase in the number of individuals, admitted with multiple co-morbidities and often with a past or present diagnosis of cancer or treatment related issues... Nurses who assist these multidimensional populations encounter evolving challenges in the delivery of safe, quality care. An additional area for nurses to consider and continue to evaluate is that of quality of life for those individuals, their families facing cancer and the possible effects of long-term sequelae. “Quality of life (QOL) for individuals with cancer should be a concern for all nurses, whether caring for patients in the hospital, clinic, private office, homecare, or a hospice setting…. QOL is an essential aspect of nursing care” (King, 2006, p. 5)
Nursing continues to expand towards a more comprehensive role in areas of patient care, research and education. Opportunities exist for all nurses including those who specialize in oncology, to impact advances in technology, therapies, and quality of life and survivorship Long-term survival is now a reality and it is now evident that the direct care provided to these individuals becomes evidence-based and comprehensive.
“Competent and comprehensive care for survivors requires that all nurses understand and assess for the broad range of long-term sequelae whenever they evaluate at-risk patients, whether in primary care, home care, the emergency room, medical-surgical unit, occupational health, or other health care setting” (Curtiss & Haylock, 2006, p. 5).
Nursing continues to evolve in response to ongoing changes in treatment options, care delivery settings, and diverse patient populations. The expertise required to deliver safe, efficient, patient-centered cancer care continues to evolve as these challenges blend with the dynamic healthcare environment of today and the unforeseen events of the future.
Ethical and legal issues, such as an increase in the availability of unproven treatments and the number of under and uninsured patients, complicate the professional indices of nursing. Nurses are obligated to interact with advances in medicine and technology, which have the ability to sustain life and potential belated long-term sequelae of these therapies. Nurses must challenge the evolving healthcare environment regarding these and other issues to remain advocates for the population.
To advance and preserve the progression of oncology nursing, national initiatives and professional, consumer and advocacy organizations have supported the adherence to standards of care, which protect the patient/families and significant others. The Oncology Nursing Society (ONS) has provided updated statements on the Scope and Standards of Oncology Nursing practice to ensure the documentation and preservation of its history and evolution. ONS exemplifies how oncology nurses have contributed to the increase of cancer survival rates in the past century; especially in the areas of prevention and early detection. ONS cites the Institute of Medicine (IOM) challenge to healthcare professionals to ensure the American Nurses Association’s (ANA) Standards of Care and Standards of Professional Performance by promoting, advocating and delivering care that is “safe, effective, patient-centered, timely, efficient and equitable” (ONS, 2003, p. 3) care. The standards offered by the ONS, published in collaboration with the ANA in 1987 and revised in 1996, provide the benchmark from which the healthcare community can move forward in designing and supporting care to meet this challenge.
ONS also highlights the ongoing need for generalist and advanced practice oncology nurses reinforce proper training to fulfill the safe, quality care patients have come to expect. The challenge of an evolving healthcare environment, ethical and legal complications, and the increasing incidence of long-term survival sequelae, has demonstrated a priority for oncology nursing to provide the leadership in caring for and in advancing the evidence-based guidelines for the changing needs of cancer patients.
In order to facilitate safe, quality patient care by RNs caring for individuals receiving chemotherapy, immunotherapy, biotherapy agents and radiation therapies, and to ensure that the rights of RNs are upheld within their legal scope of practice, the New York State Nurses Association recommends that:
The RN has the responsibility to:
The facility should be responsible for:
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
Approved by the Board of Directors on 6/07. This position statement was developed under the direction of NYSNA's Council on Nursing Practice.
American Cancer Society (2006) Cancer Facts & Figures 2005. Atlanta: Amercian Cancer Society.
Boyle, D. A., Bruce, S. D., Iwamoto, R. R., & Summers, B. L. (2004). Statement on the scope and standards of oncology nursing practice. Pittsburgh, PA: Oncology Nursing Society.
Curtis, C. P., & Haylock, P. J. (2006). State of the science. Editorial: Survivor-centered care. American Journal of Nursing, 106(3S), 4-11.
Ferrell, B. R., Virani, R., Smith, S., & Juarez, G. (2003). The role of oncology nursing to ensure quality care for cancer survisors: A report commissioned by the National Cancer Policy Board and Institute of Medicine. Oncology Nursing Forum, 30(1), E1-E11.
King, C. R. (2006) Advances in how clinical nurses can evaluate and improve quality of life for individuals with cancer. Oncology Nursing Forum 33 (S1), 1-12
National Cancer Institute (2006). Retrieved on January 26, 2007 from www.cancer.org
Polovich, M., White, J.M., & Kelleher, L.O. (2005). Chemotherapy and biotherapy guidelines and recommendations for practice, 2nd ed. Pittsburgh, PA: Oncology Nursing Society.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.