By Stefanie Dell’Aringa
The number of patients with cancer is expected to rise 42% by 2025, according to the American Society of Clinical Oncology, but nurse practitioners trained for primary care sometimes lack oncology experience.
“They’re coming out of school with knowledge gaps,” said Tracy Krimmel, MSN, RN, AOCN, APRN-BC, nurse manager of adult oncology clinical services at the Rutgers Cancer Institute of New Jersey, New Brunswick.
Rutgers is addressing the issue by offering an Advanced Practice Nursing Fellowship program that gives NPs specialized training in cancer care.
Krimmel worked with Janet Gordils-Perez, MA, RN, ANP-BC, AOCNP, executive director/oncology nursing services at CINJ, and Renee Kurz, MSN, RN, FNP-BC, instructor at Rutgers University’s School of Nursing, to develop the program. In April, they gave a poster presentation at the Oncology Nursing Society’s 40th annual Congress, where nurses nationwide learned about the program’s outcomes and sustainability.
The goal of the program is to retain NPs at CINJ and improve their comfort level by preparing them to practice confidently and independently, and handle complex challenges specific to oncology patients, such as pain management and end-of-life issues.
“We were having some challenges when interviewing new nurse practitioners who had very little or no oncology experience,” Gordils-Perez said. “We were finding that they were not able to practice independently after their orientation or even months after that.”
During the six-month fellowship program, NPs make palliative care rounds, work in multiple clinics and meet with advanced practice nurses. Mentorship and clinical rotations are coupled with a 36-credit hour online course through the ONS.
“We want to make sure they’re experts in what they do,” Gordils-Perez said. “It should translate into improved patient care outcomes.”
Fellowship program training is individualized and can include how to take a patient’s history, assess, present cases to physicians and disseminate information about clinical trials to patients.
“We’re helping nurse practitioners understand the different phases of clinical trials because our mission is to get patients on clinical trials,” Gordils-Perez said.
NPs are given questionnaires before starting the program to assess their needs so training can be tailored to their specific goals, Kurz said. One of the students, for example, plans to specialize in surgical oncology.
“He (was able) to shadow a surgeon and watch the surgeon perform some GI oncological surgery,” Kurz said.
Another NP who had not worked in gynecologic oncology made rounds with an inpatient gynecologic oncology NP.
“She thought that was very helpful,” Krimmel said.
Kurz conducted research and piloted the program last summer with four students. Data she analyzed from pre- and post-testing revealed improved competencies in planning, treatment, implementation and management of oncologic emergencies.
Student evaluations of the specialized program have been favorable, according to the organizers.
“Their comfort level and knowledge base was improved,” Krimmel said. “They rated their mentors very high as well.”
The fellowship program is one of three in the nation, according to CINJ. Ohio State University Comprehensive Cancer Center/James Cancer Hospital and Solove Research Institute, Columbus, offers a similar program, as does the MD Anderson Cancer Center at the University of Texas, Houston.
“Others are most likely going to go to this type of model,” Kurz said. “We need to provide nurse practitioners with additional knowledge and training, and this is one way to give it to them.”
In the future, Kurz hopes NPs at Rutgers will have the opportunity to specialize in oncology.
“We’d like to offer a DNP with an oncology specialization as well as a certification program in oncology nursing for APNs,” Kurz said. “Hopefully, we’ll be rolling that out next year.”
Stefanie Dell’Aringa is a freelance writer.
Fellowship program at Rutgers prepares nurses for oncology patients
By Stefanie Dell’Aringa