M. D. Anderson Paves Academic Route to Oncology Nursing Excellence : Oncology Times

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Eric Rosenthal reports

M. D. Anderson Paves Academic Route to Oncology Nursing Excellence

ROSENTHAL, ERIC T.

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doi: 10.1097/01.COT.0000335049.28188.93
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Late in August three figurative batons will be exchanged between six nurses enrolled in a unique academic program pioneered at the University of Texas M. D. Anderson Cancer Center when the second-year class of Post Graduate Fellows in Oncology Nursing graduates and makes way for the incoming third-year class.

The six women are part of an exclusive club of eight oncology nurses who've participated in an innovative program providing advanced practice nurses with experience in a one-year oncology nursing fellowship program that combines academic training at the University of Texas Health Science Center School of Nursing with a core curriculum of clinical study at M. D. Anderson.

During 12 months fellows are exposed to the full range of oncology care: from prevention to end-of-life, and select a specialty area in oncology for future practice.

The program is the first attempt to provide a sustained academic structure for those who already have an RN and a clinical master's degree in nursing, are either a clinical nurse specialist or nurse practitioner, and have had three years of clinical experience including in the advanced practice role; and who want to achieve oncology nursing excellence through a channel other than the traditional on-the-job training apprenticeship model.

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Chief Nursing Officer Barbara L. Summers, PhD, RN, NEA-BC: “It is critically important that we have a pipeline of well-prepared advanced practice nurses who can step into the oncology practice environment and be functional as rapidly as possible.”

It is also a means of trying to ensure that qualified oncology nurse practitioners are available to help with the increased need for cancer patient care prior to the oncologist shortage projected by 2020.

Until the program began in 2006 there was no equivalent mechanism for advanced practice oncology nurses to partake in fellowship training similar to that of fellowships for oncologists.

To date, a few other cancer centers have expressed interest in developing programs, but for less comprehensive, much shorter training periods.

The M. D. Anderson program provides its fellows with paid, full-time positions during training and almost guaranteed post-fellowship employment there as well.

And even though most graduates have received about five job offers upon graduation they've all remained at the center.

During the Oncology Nursing Society Congress in Philadelphia in May, I spoke with the architect of the program, Barbara L. Summers, PhD, RN, NEA-BC, Vice President, Chief Nursing Officer, and Head of Nursing at M. D. Anderson.

And a few weeks later at the American Society of Clinical Oncology Annual Meeting in Chicago, I also spoke to M. D. Anderson President John Mendelsohn, MD.

Dr. Summers said that when she was promoted to Chief Nursing Officer in 2004 she conducted an assessment of the nursing practice workforce and environment at M. D. Anderson and concluded the institution relied very heavily on advanced practice nurses to support the patient care delivery process.

“I recognized that it was critically important that we have a pipeline of well-prepared advanced practice nurses who were able to step into the oncology practice environment and be functional as rapidly as possible,” she said.

“Typically when we recruit advanced practice nurses external to the organization they come in with no cancer background at all and are really at a disadvantage, since it generally takes them a good deal of time to ramp up their knowledge to be fully participating members of the cancer care team.”

Vision Made Reality

Her vision of the fellowship was turned into a reality by Joyce E. Dains, DrPH, JD, RN, FNP-BC, NAP, Director of the center's Advanced Practice Nursing Program.

During a telephone interview Dr. Dains explained that a steering committee of nurses from both the cancer center and nursing school determined the program's curriculum, what pieces would be shared, and the focus of both the academic and clinical aspects.

“We also needed the buy-in from our stakeholders, which meant all the service departments at M. D. Anderson, all the advanced practice nurses who would be precepting our fellows, and other members of the nursing department.”

She acknowledged that the Oncology Nursing Society has been instrumental in providing a source of formal continuing education in cancer nursing practice, but this was the first formal academic post-graduate fellowship in advanced practice oncology nursing, and “is absolutely consistent with our mission area of education.”

Both members of the first class were internal candidates (see box) who were clinical staff selected to ensure the program was getting set up to be successful, Dr. Summers said.

The second and current class is more diverse in background, with experience in women's health (see box), acute care adult health, and pediatric cancer at non-comprehensive cancer centers.

And the third, incoming class are all advanced practice nurses with limited cancer experience from Houston, Ohio, and Wyoming who are interested in specializing in oncology.

Dr. Mendelsohn said that in most situations M. D. Anderson does not have house staff on the floors, so physicians have been collaborating with nurses to deliver care for a long time.

“We have oncology fellows, but the traditional day-to-day hands-on care of patients has been much more pairing up with the nurse while the doctor goes off and does other things rather than handing it off to a house officer.

Nearly 300 NPs, APNs, & PAs

“It turns out that because of the wonderful experience we've had with nurses that they've been getting a lot more responsibility, and we now have nearly 300 nurse practitioners and other advanced practice nurses, in addition to our physician assistants,” he said.

The question was, Dr. Mendelsohn said: “Do you train them in the old guild fashion with the doctor who hires them teaching them, or do you actually have some formal training where you create a professional program?

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M.D. Anderson President John Mendelsohn, MD: “I'm hoping that this will become a career path that will have some kind of certification.”

“I believe in the dual-mission concept. Everyone who works at M. D. Anderson has the mission to make cancer history, but they also have as their personal mission their own life, and if we are going to be the employer of choice—which is one of our seven strategic goals—then we have to make the opportunities available for everybody, not just the doctors, but also the nurses, the secretaries, everybody.

“It's their career and so it made sense to me and it certainly made sense to the nursing department to create a career pathway,” he continued. “There's no board for this, there's no official certification, so we are going to give our own certificate working in collaboration with the UT Health Science nursing school, and what I'm hoping is this will become a career path that will have some sort of certification.”

Impetus: Projected Shortage of Oncologists

He added that the projected shortage of oncologists was an impetus for the program, and that from society's point of view it would probably be more effective and less expensive to increase the number of well-trained oncology nurse specialists.

“This is a small program, but I'd like to see this program grow,” Dr. Mendelsohn said. “It's only two years old now, and I don't know what the logistics are that would keep it from happening and I don't know what investments I would have to make as an institution to make it a class of 30 some day.”

M. D. Anderson has been dedicated to training the infrastructure of medicine, he said, and for the past decade has offered undergraduate degrees in medical technology, as well as sponsored various hospital management internships for administrators.

“We are looking at the big, big, big picture. We need an infrastructure of talented people who can handle the technology. We are more focused than anywhere I have ever worked where the clinical mission is part of the academic mission. We want to eliminate cancer through patient care, research, education, and prevention, and the first thing listed is patient care,” he said.

“Everyone is trying to do all of them, but at M. D. Anderson we have incorporated patient care as the number one thing we are concentrating on in an academic as well as clinical sense, and we treat it that way. We have a little more emphasis on patient care as something to be pursued intellectually and supported.”

© 2008 Lippincott Williams & Wilkins, Inc.
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