Role of the Oncology Nurse:
Oncology nurses practice in a variety of settings including acute care hospitals, ambulatory care clinics, private oncologists' offices, radiation therapy facilities, home healthcare agencies, and community agencies. They practice in association with a number of oncologic disciplines, including surgical oncology, radiation oncology, gynecologic oncology, pediatric oncology, and medical oncology. The majority of oncology nurses are involved in direct patient care and practice at the generalist level, with 43% working in a hospital/multihospital system, 24% in the outpatient/ambulatory care setting, 11% in physician offices, and 3% in hospice or home care. Positions in the outpatient and home care setting have increased as more patients are being treated out of the hospital setting. The roles of the oncology nurses vary from the intensive care focus of bone marrow transplantation to the community focus of cancer screening, detection, and prevention.
Nurses are expected to be expert in assessing a patient's physical and emotional status, past health history, health practices, and both the patient's and the family's knowledge of the disease and its treatment. The oncology nurse reviews the treatment plan with the oncologist, is aware of expected outcomes and possible complications, and independently assesses the patient's general physical and emotional status.
The nurse often has a better opportunity than any other member of the healthcare team to develop the required rapport for effective educational efforts with patients and their families. Patient and family education starts before therapy and continues during and after therapy. Continual reinforcement throughout the treatment course helps to ensure success.
Coordination of Care
The oncology nurse plays a vital role in coordinating the multiple and complex technologies now commonly employed in cancer diagnosis and treatment. This coordination encompasses direct patient care; documentation in the medical record; participation in therapy; symptom management; organization of referrals to other healthcare providers; both patient and family education; as well as counseling throughout diagnosis, therapy, and follow up.
Direct Patient Care
The majority of oncology nurses provide direct patient care involving chemotherapy. National certification for chemotherapy currently does not exist. Each institution should have written policies for chemotherapy certification, administration of antineoplastic drugs (all routes), safe drug handling and disposal, management of untoward reactions, such as allergic reactions, and methods for documentation. The oncology nurse currently offers a chemotherapy trainers course.
Oncology nurses are challenged on a daily basis to deal with the numerous symptoms patients with cancer and their families encounter as a result of their cancer or its treatment. Nurses triage patient problems and assist in the evaluation of symptoms and initiation of interventions. For example, subjective and objective data, including information about the last chemotherapy treatment and knowledge of the patient's history, guide the nurse in determining the patient's disposition and treatment.
Oncology nurses are closely involved with numerous supportive care issues encountered by cancer patients and their families. This chapter does not allow a detailed discussion of the numerous areas of supportive and palliative care, but two areas deserve special mention, that is, the involvement of nurses in pain management and in survivorship.