Advance practice nurse role extended over decades from a limited restricted role to advance and multidisciplinary role. As specialty within nursing field varies, nurse role varies too from ordinary register nurse to advance practitioner nurse. The oncology department as like other spatiality required a staff nurse who’s qualified to practice their missions with the advance requirements.
'Smith BD, 2009 stated that: Advanced Practice Registered Nurses (APRNs) and Physicians Assistants (PAs) are essential to interdisciplinary care of oncology patients. Generally titled in the United States as Advanced Practice Providers (APPs), APRNs and PAs have continued to develop their practice patterns and enhance their roles in oncology care. With the ongoing health care reform, a projected increase in cancer incidence (Smith BD, et al.2009) and predicted shortage of oncology physicians (Erikson C, et al, 2007)'.
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Enormous number of APRNs are Nurse Practitioners (NPs) as studies have shown the American Association of Nurse Practitioners (AANP) reports that there are over 205,000 NPs in the United States in 2015 with 1.2% of these NPs practicing in clinical oncology (AAONP,2015), also within the Arab Gulf region APN roles started growth newly to compete worldwide.
The nurse practitioner (NP) role in Canada has been established several years ago with noticeable changes. Particularly in cancer care, increasing incidents and rising cancer cases voluminous, triggered the need to expand the healthcare workforce to provide patient care. Although researches up to days have to approve that NPs give high-quality care with excellent patient outcomes, a continuous as stated by DiCenso & Bryant-Lukosius: “lack of role clarity and acceptance has hindered the implementation of this role and constrained its potential to contribute to meaningful system change (DiCenso & Bryant-Lukosius, 2010).'
Cancer care is recognized by its interprofessional and multispecialty model. “The ASCO Fall 2008 Workforce Statement urged the development of the workforce to ensure continuous delivery of high-quality cancer care.'
Kingdom of Bahrain at the health sector & oncology department showing a conspicuous effort in providing care for a cancer patient, as well that care evolves a multidisciplinary team to ensure transferring high quality of care. So, the future vision in the kingdom of Bahrain involves an APN in the health care sector to bring up the care quality to a universal standard.
Through this paper I will describe the advanced practice nursing scope of practice at oncology, supporting this subject with literature review, discussing oncology APN worldwide view and Kingdom of Bahrain intention toward raising oncology APN, designing an action plan as followed internationally and suitable for oncology department at Bahrain hospitals, lastly, the recommendations for future oncology APN role will be set.
Oncology scop of practice
In oncology, as in other practice settings, the advanced practice nurse is a “registered nurse, prepared with a minimum of a Master’s degree in nursing, who has acquired in-depth knowledge and clinical experience in oncology” (Canadian Association of Nurses in Oncology, 2001, p. 61).
Advanced practice roles have existed in many countries for more than 40 years, but the use of these roles has been hindered by role clarity and scope of practice issues and has ebbed and flowed depending on government, physician, administrative, and public support (Andregárd & Jangland, 2015; DiCenso & Bryant-Lukosius, 2010; Kleinpell, Hudspeth, Scordo, & Magdic, 2012). In the kingdom of Bahrain, the scope of practice at the oncology department will enable APN with a master or doctorate degree holder to provide care within different aspects, leadership, education, coaching, administering chemo-radiotherapy modalities, admission, and discharge plan.
The number of new cancer cases in the United States is expected to increase from 14 million in 2012 to 22 million in the next two decades (National Cancer Institute, 2017). However, shortages of healthcare professionals, numerical growth in the population of older adults, additional treatment options, increases in cancer survivorship, and expanded access to health care through the Patient Protection and Affordable Care Act have resulted in the proliferation of oncology nurse practitioner (NP) roles and responsibilities as oncologists struggle to handle the increasing demand for oncology services (Erickson, Salsberg, Forte, Bruinooge, & Goldstein, 2007).
Advanced practice nurses deliver high-quality, cost-effective care while improving healthcare access (Elliott & Walden, 2015). The role has evolved since its development in the 1960s to meet the ongoing demands of the healthcare environment (American Academy of Nurse Practitioners, n.d.), resulting in an increased presence of NPs in specialty-based practices.
A majority of NPs working in the oncology setting have completed graduate programs that did not focus on the specialty (Oncology Nursing Certification Corporation [ONCC] 2008 survey, data not published). Cancer care reaches across all patient populations, making no NP educational preparation (eg, family, adult, acute care, and women’s health) entirely adequate for the care of patients with cancer and their families.
The oncology NP (ONP) has been providing care in a variety of primary, acute, and tertiary settings, including physician practices. ONPs are also beginning to practice at nontraditional health care sites, such as survivorship and symptom management clinics as well as high-risk and early detection clinics, demonstrating the unique skills ONPs have to offer in the delivery of quality cancer care. In multiple care settings, evidence has demonstrated the cost effectiveness, patient satisfaction, and quality care outcomes produced by NPs, prompting this growth of ONPs in cancer care (Bush N, Watters T, 2001, Mandelblatt J, et al, 1993).
SCCC is a university-based cancer center in South Florida with more than 60 NPs on staff. A first essential step was determining the resources available and understanding the training models already offered at other cancer centers; this helped the program developers at SCCC (NP leaders) in the development of a fellowship program offering valuable skills tailored to any oncology subspecialty (Maritza C, 2018).
NPs have competencies that are relevant to the challenges facing health care today (Spross & Heaney, 2000). The NP role has been seen as a way to address service gaps, physician workload, lack of continuity of care, and less-than-optimal careinterventions (Andregárd & Jangland, 2015; Kilpatrick et al., 2010).
ONS is the professional home of more than 37,000 RNs and other health care providers dedicated to excellence in patient care, education, research, and administration in oncology nursing. ONS recognizes the value ONPs bring to the interdisciplinary oncology team and has assumed a leadership role in providing education to generalist NPs and in advocating for the NP role in oncology (Brenda N,2010).
The oncology NP (ONP) has been providing care in a diversity of primary, acute, and tertiary settings, including physician practices. ONPs are also beginning to practice at nonordinary health care missions, such as survivorship and symptom management clinics as well as high-risk and early detection clinics, representing the unique skills ONPs have to offer in the delivery of quality cancer care. In multiple care settings, evidence has demonstrated the cost-effectiveness, patient satisfaction, and quality care outcomes produced by NPs, prompting this growth of ONPs in cancer care (Bush N, Watters Ritz stated: “Improved outcomes have been documented in quality of life and cost outcomes in breast cancer care (Ritz L.et al, 2000)”, but Rosenzweig MQ in 2006 concluded these must be further clarified in important subspecialties such as cancer survivorship (Rosenzweig MQ, 2006). NPs are uniquely educated at the master’s or doctoral level to provide quality care within a comprehensive health promotion framework (NONPFS, 2006). Equivocal or superior patient outcomes by advanced practice nurses in primary (Mudinger MO et al,2000) acute specialty (Hoffman L er al, 2005) and home-based cancer care (McCorkle R et Particular strengths of NPs are patient education, communication, duration of visits (Mudinger MO et al,2000) and adherence to evidence-based practice guidelines. In the Kingdom of Bahrain the oncology services provided by a specialist nurse who’s qualified to administer a chemo-radiotherapy, the APN role will be designed advance extended role to enable the future APN in Bahrain to plan the admission and discharge at in and outpatient setting, coaching the cancer patient about the chemo and non-chemo agents and how to control possible side effect, arranging home visits to follow up the cases, education for the registered nurse about new treatment modalities based on evidence-based practice.
At salmaniya medical complex place where I work at oncology department, there is no APN role yet established, but the future vision of ministry of health to involve this designation to fulfill the advance care setting, so, I choose an international action plan that can meet the requirement of this post. At appendix an action plan for oncology APN added.
My role as APN student I recommend through this paper assignment to emerge an APN designation with an advance competency to counteract the increased number of cases and to ease the work flow. However, it is important to note that most oncology ANPs have had a signiﬁcant sum of experience working as RNs in the specialty of oncology before becoming NPs. Additional education and training are speciﬁc to this unique role that is necessary for the provision of safe and appropriate care for patients with cancer and their families across the cancer care trajectory.
Advanced Practice Registered Nurses (APRNs) are essential components to interdisciplinary care of cancer patients, as cancer cases increasing in number the needs to oncology APN increase. The value of oncology APN brings to the interdisciplinary oncology team and has expected a leadership role in providing education to NPs and in encouraging the NP role in oncology.
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