Standardizing Assessment of - CEConnection · Standardizing Assessment of Competences and Competencies of Oncology Nurses Working in Ambulatory Care Clara Beaver, MSN, RN, AOCNS,

Standardizing Assessment ofCompetences and Competenciesof Oncology Nurses Working inAmbulatory Care

Clara Beaver, MSN, RN, AOCNS, ACNS-BC ƒ Morris A. Magnan, PhD, RN ƒDenise Henderson, MEd, BSN, RN ƒ Patricia DeRose, MPA, RN ƒKathleen Carolin, MSA, BSN, RN ƒ Gerold Bepler, MD, PhD

A nursing quality consortium standardized nursing practice

across 17 independently functioning ambulatory oncology

sites. Programswere developed to validate both competences

and competencies. One program assessed nine competences

needed to develop systems of care to detect and treat

treatment-related side effects. A second programwas developed

to assess competencies needed to prevent harm to oncology

patients. This manuscript describes a successful approach to

standardizing nursing practice across geographically distant

academic and community sites.

Before joining forces to create the largest cancernetwork in Michigan in 2014, key leaders of theKarmanos Cancer Institute and McLaren Health

Care met to discuss a strategic architecture for clinicaland research integration as well as overall organizationalalignment. Several guiding principles were identified, in-cluding onewhich focused on developing a ‘‘first of a kind’’hybrid academic community model to elevate the qualityof care, outcomes, economics, clinical research, and edu-cation. Shortly thereafter, the Karmanos/McLaren Ambulatory

Oncology Nurse Quality Consortium (AONQC)was formedand charged with several responsibilities, including that ofensuring standardization of nursing practice across allambulatory oncology sites. The enormity of this undertak-ing cannot be fully appreciated until one considers thatnursing practice at 17 essentially distinct and functionally in-dependent cancer care venues inMichigan’s LowerPeninsulaneeded to align to ensure that an equitable standard of high-quality nursing care was being provided at each venue.

The AONQC is essentially a recommending body com-prised of clinical experts and administrative nurses fromboth academic and community sites. AONQC memberswere selected formembership by senior levelmanagementbased on their perception that eachmember brought a dis-tinct level of expertise to the group with less considerationgiven to achieving representation of all academic and com-munity sites. Entrusting the AONQC, a quality consortium,with responsibility for standardizing nursing practice is aunique arrangement. As a recommending body, theAONQChas no legitimate authoritywithin the organizationto write policy or implement nursing practice guidelines.Typically, nursing administration, nursing education,boards of nursing, or credentialing entities are given au-thority and responsibility for setting standards of nursingpractice and assuring initial and ongoing competent nurs-ing practice to meet those standards (Scott Tilley, 2008). Asa first step toward standardization of nursing practiceacross all 17 of the network’s venues, the AONQC choseto ensure that nurses at each venue were competent to de-liver high-quality oncology nursing care. This manuscriptprovides an overviewof thework of theAONQC to developand implement a system-wide process to assess compe-tences and competencies of registered nurses working inoncology ambulatory clinics and infusion centers. Themanuscript first makes a distinction between competenceand competency and then presents a point of view aboutcompetence and competency in the realm of nursing prac-tice. Approaches to assessing selected competences andcompetencies pertinent to oncology nursing practice are

Clara Beaver, MSN, RN, AOCNS, ACNS-BC, is Manager, AmbulatoryOperations,Wertz InfusionCenter,KarmanosCancerCenter,Detroit,Michigan.

Morris A. Magnan, PhD, RN, is Clinical Nurse Specialist, KarmanosCancer Center, Detroit, Michigan.

Denise Henderson, MEd, BSN, RN, is Educator, Patient and Commu-nity Education, Karmanos Cancer Center, Detroit, Michigan.

Patricia DeRose, MPA, RN, is Director, Oncology Services, McLarenGreater Lansing, Michigan.

Kathleen Carolin, MSA, BSN, RN, is Senior Vice President, Ambulatoryand Support Services, Karmanos Cancer Center, Detroit, Michigan.

Gerold Bepler, MD, PhD, is President and Chief Executive Officer,Karmanos Cancer Institute, Detroit, Michigan.

The authors have disclosed that they have no significant relationships with,or financial interest in, any commercial companies pertaining to this article.

ADDRESS FOR CORRESPONDENCE: Clara Beaver,MSN, RN, AOCNS,ACNS-BC,Wertz Infusion Center, Karmanos Cancer Center, 4100 John R,Mailcode: WE01IC, Detroit, MI 48201 (e<mail: [email protected]).

DOI: 10.1097/NND.0000000000000250

2.5 ANCCContactHours

64 www.jnpdonline.com March/April 2016

JNPD Journal for Nurses in Professional Development & Volume 32, Number 2, 64Y73 & Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

presented. Finally, insights into factors that facilitated suc-cessful implementation of the competence and competencyassessment programs are discussed.

COMPETENCE AND COMPETENCYThe terms ‘‘competence’’ and ‘‘competency’’ often are usedinterchangeably. However, the literature suggests thatthese terms should be used to signify two distinct attri-butes of individuals (Alspach, 1992; McMullan et al.,2003; Schroeter, 2009; Scott Tilley, 2008). Competencerefers to the attribute of having in one’s possession theknowledge, skills, and abilities necessary to perform atask, duty, or job (Alspach, 1992; Roe, 2002). In other words,competence implies that what the individual needs to effec-tively complete a job or task is present and sufficient toactually perform the job or task competently. One mightthink of competence as being in possession of ‘‘anteced-ent’’ knowledge and skills needed to complete a job ortask. In contrast, competency refers to how adept one isat actually performing a job or task according to some stan-dard established by institutional policies, best-practiceguidelines, or professional standards of practice (Schroeter,2009). The assessment of both competence and compe-tency is a central concern for educators and administratorsin practice disciplines such as nursing, medicine psychol-ogy, and physical/occupational therapy (Bhalla et al., 2014;Roe, 2002; Sakurai et al., 2013; Scott Tilley, 2008; Watson,Stimpson, Topping, & Porock, 2002). Although much ofthe literature on competence and competency focuses onidentifying valid approaches to assessing attributes of stu-dents during the preservice period of their education, thereis a growing interest in validating both competences andcompetencies of postgraduate professionals in their workenvironments (Case Di Leonardi & Biel, 2012; Przybyl,Androwich, & Evans, 2015; Roe, 2002).

The Joint Commission requires organizations to assessstaff competences and competencies at the time of hireand on an ongoing basis (Joint Commission, 2015). How-ever, the work of identifying what knowledge, tasks,duties, and skills should be assessed as well as determininghow to assess them is the responsibility of the employer.When designing assessments, it is best to remember thatno single assessment strategy will be suitable for all situa-tions (Wright, 2005). Nurses’ movement from specialty tospecialty requires that they acquire new knowledge anddevelop new skills; thus, assessments of competencesand competencies in professional practice need to be tailoredto specific circumstances of nursing practice (Lundgren &Houseman, 2002).

COMPETENCE AND COMPETENCY IN THEREALM OF NURSING PRACTICEUnderstanding competence and competency related tonursing practice begins with insights into the realm of

nursing practice and the respective aims and desired re-sults associated with diverse systems of nursing practice.The realm of nursing practice can be characterized asconsisting of three systems of nursing practice: the socialsystem, the interpersonal system, and the technologicalsystem (Banfield, 2011; Orem, 2001). The social system re-fers to the ways nurses and persons come together and theprofessional and contractual relations that are in place. Theaimof the social system is to bring about, ideally, an explicitagreement between the nurse and patient such that thenurse expresses a willingness to provide nursing careand the patient expresses a willingness to receive nursingcare. The interpersonal system involves the personal rela-tions between nurses and persons receiving care, includingfamily members. Nurses sometimes misconstrue the inter-personal system of care as being nothing more than theestablishment of a ‘‘caring’’ interpersonal relationship. Thisnotion does not consider that the aim of establishing an in-terpersonal relationship or connection with patients andfamilies is ‘‘to minimize patient stress and enable the pa-tient and family members to act responsibly in matters ofhealth and health care’’ (Orem, 2001, p. 101). The techno-logical system of nursing practice refers to the processesthroughwhich nurses identify the requirements for nursingcare, design systems for the provision of the required care,and engage in the delivery of this care. The aim of the tech-nological system of practice is to design and deliversystems of care that bring about conditions and events that(a) lead to positive changes in the patient’s health state, (b)prevent harm, and (c) prevent deterioration of the healthstate. Although competences and competencies are re-quired in all three systems of nursing practice, an immediateconcern for the AONQC team members was addressingcompetences and competencies of nurses related to as-pects of the technological system of practice that arecommonand recurring features of oncology nursing prac-tice situations. Two categories of common, recurringfeatures of oncology nursing practice situations were iden-tified: (a) situations where patients are vulnerable to orexperiencing adverse effects from their treatment and (b)situations where patients are at risk of harm during theadministration of chemotherapeutic agents or throughunwarranted exposure to chemotherapy agents.

ASSESSING ANTECEDENT KNOWLEDGENEEDED TO DESIGN SYSTEMS OF CARETO DETECT AND MANAGETREATMENT-RELATED SIDE EFFECTSNursing practice is a practical endeavor in the sense thatthe provision of nursing care is directed toward the ac-complishment of some goal. Often, the goal orientationfor nursing practice is to prepare patients for conditionsor events that have a high probability of occurring but donot currently exist. An example of commonly occurring

Journal for Nurses in Professional Development www.jnpdonline.com 65


high-probability events is the adverse treatment-relatedside effects experienced by some oncology patients. Anursing goal in this situation is to design systems of carethat facilitate the patient’s early detection of specific sideeffects and lead to effective self-management of the sideeffect when it does occur. Nurses cannot design and/or de-liver effective systems of care in these situations withouthaving some degree of mastery of a body of antecedentknowledge. For example, a nurse cannot design an effectivesystem of care for a patient experiencing cancer-relatedfatigue (CRF) if he or she does not have prior (antecedent)knowledge of the natural history of CRF (its onset, severity,and duration) for a particular individual. The nurse mustalso know its causes, manifestations, and consequencesand have prior knowledge of valid, evidence-based waysof managing CRF. On the basis of this need, AONQCmem-bers determined that assessing nurses’ mastery of antecedentknowledge about commonly occurring side effects of cancertreatment (chemotherapy and/or radiation therapy) wouldbe an appropriate focus for validating clinical competenceof nurses in the technological systemof practice. Validatingthat oncology nurses possess the requisite antecedentknowledge to design an effective system of care that willhelp patients recognize and manage adverse treatment-related side effects does not ensure that the care will bedelivered competently or at all. When teaching patientsabout treatment-related side effects, essential features ofan effective system of care will include (a) an assessmentof the patient’s current knowledge base, readiness to learn,and barriers to learning; (b) a structured teaching plan thatis tailored to the patient’s learning style and literacy; and (c)an evaluation or feedback component to validate thatlearning has taken place. Delivering a system of care canbe thwarted by environmental factors (e.g., an emergencyon the unit), time constraints, and/or patient unwillingnessor inability to participate in care. Nevertheless, adminis-trators and educators need to be sure that any failure todeliver requisite nursing care is not due to the nurse’slack of antecedent knowledge.

Nine side effects of cancer treatment (chemotherapyand/or radiation therapy) were targeted including CRF, can-cer pain, constipation, nausea and vomiting, diarrhea,mucositis, chemotherapy-induced peripheral neuropathy,radiation dermatitis, and psychosocial distress. These sideeffects were chosen because they are commonly occur-ring, have a direct impact on the patient’s quality of life,and can influence a patient’s ability to complete the pre-scribed treatment without interruption (Eilers, Harris, Henry,& Johnson, 2014; Feight, Baney, Bruce, & McQuestion, 2011;Fulcher & Gosselin-Acomb, 2007; Irwin, Lee, Rodgers,Starr, & Webber, 2012; Mitchell, Beck, Hood, Moore, &Tanner, 2007; Muehlbauer et al., 2009; Oncology NursingSociety, 2014;. Tofthagen, Visovsky, &, Hopgood, 2015;Woolery et al., 2008). To assess competences, educational

content and test questionswere developed for each topicalarea by AONQCmembers working in dyads consisting of aprincipal author and a reviewer. All content developerssubmitted their educational programs in the form of aPowerPoint presentation prepared according to specificpredetermined criteria (see Figure 1).

Final approval of each presentation (content and testquestions) was based on a review by an expert panelconsisting of a doctorally prepared clinical nurse specialist,a board-certified advanced practice oncology nurse, andtwo nurse educators. During this review, the expert panelappraised (a) appropriateness of learner objectives, (b) ac-curacy of the content, (c) adequacy of the content toachieve the stated objectives, (d) logical flow, (e) unifor-mity of format across presentations, (f) test questions toensure they could be answered based on the contentpresented, (g) proposed treatment interventions to en-sure they were in keeping with Oncology Nursing Society(ONS) ‘‘putting evidence into practice’’ guidelines, and(h) American Psychological Association format style. Thecontent areas developed, the number of slides, the numberof test questions, and the estimated time for completion foreach program are shown in Table 1. The minimal pass rateon each test was set at 80% based on recommendationsmade by corporate level nurse educators.

The estimated time required for individual staff membersto complete competence validation related to antecedentknowledge of commonly occurring treatment-related sideeffects was considerable; approximately 2.5 hours if unin-terrupted. Therefore, upper levelmanagementwas consultedto secure full administrative support for competence vali-dation, establish a time frame (in months) for staff tocomplete the validation content, and agree upon reimburs-ing staff for completing the validation process. Throughthese meetings, vice presidents of ambulatory care forMcLaren and Karmanos reviewed the content with theirrespective managers and clinical leaders and fully en-dorsed the proposed validation programs. Administratorsagreed that existing staff should complete all competence

FIGURE 1 Criteria for developing PowerPoint presentations and questionsto assess competences related to cancer treatment side effects.



validation within 4 months and that staff could use time atwork to complete the competence validation but no overtime would be paid for this activity.

To date, all educational programs with test questionshave been loaded into the computer-based learning andtesting system (Health Stream). One hundred thirty em-ployees are scheduled to complete the competence vali-dation programs. In addition, inpatient directors andmanagers have expressed a keen interest in having theironcology registered nurse staff complete these same com-petence validation programs.

ASSESSING COMPETENCIES NEEDED TOPREVENT HARMNurses working in chemotherapy infusion centers regu-larly face the challenge of developing and deliveringnursing systems of care thatwill protect patients fromharm.The potential for error exists at every step of the chemo-therapy process (Sheridan-Leos, 2007), but chemotherapypatients can be harmed in other ways as well. Three areasof major concern are (a) minimizing the risk for infectionamong patients who are actually or potentially immuno-compromised, (b) ensuring that the chemotherapy de-livered is correct in every detail, and (c) safe handling ofchemotherapy to minimize patient and staff exposure tohazardous drugs. Oncology nurses’ use of impeccable,flawless technique to gain venous access and deliver che-motherapeutic agents as well as the use of a systematic pa-tient medication verification processes are essential toprotect patients from harm. Similarly, systematic, approvedapproaches to managing chemotherapy spills are essentialto minimize patient and staff exposure to hazardous drugs.Direct observation can be used to validate nurse compe-tencies with respect to use of flawless technique, to verifythat nurses competently employ a systematic approach to

patient medication verification, and to validate safe han-dling of chemotherapy and management of chemother-apy spills.

At Karmanos Cancer Institute, well-qualified nurse pre-ceptors and clinical nurse specialists have used directobservation and detailed checklists for many years to vali-date competencies of nurses working in our infusioncenters. Figure 2 shows a list of 20 behavioral competenciesfor which checklists have been developed. Determininghow to best implement a similar direct-observation-using-checklists process across all community siteswas a challenge.The AONQC team determined that a train-the-trainer ap-proach would be best. Before implementing our train-the-trainer approach, AONQC members drew upon theirexperience as educators and preceptors to identify charac-teristics that competency assessors must possess (seeFigure 3). Then, the educators developed a program to in-troduce competency assessors to the principles andmethods of competency assessment. Finally, prospectivecompetency assessors attended a ‘‘competency assessortraining’’ programwhere they received didactic instructionin competency assessment as well as instruction in the useof direct observation using checklists. Instruction was pro-vided by an ONS board-certified advanced practice nurseand an ONS-certified nurse preceptor. Teach back and re-turn demonstration were used to determine prospectiveassessors’ readiness to function capably as a competencyassessor. Not all items from the list of 20 behavioral compe-tencies were relevant for all community sites. For example,intravesical administration and intrathecal administrationof chemotherapy are not done at most of the communitysites. Consequently, prospective assessors were not heldaccountable for assessing staff competencies for proce-dures not performed at their facility. An example of adirect observation checklist to validate competencies related

TABLE 1 Topical Areas for Competence Assessment

Topical AreasNumber of Slides IncludingTitle Page and References Number of Questions

Estimated Time to CompleteContent and Test

Mucositis 19 7 20 minutes

Cancer-related fatigue 22 7 15 minutes

Psychosocial distress 20 6 20 minutes

Cancer pain 24 6 30 minutes

Chemotherapy-inducedperipheral neuropathy

18 8 20 minutes

Nausea and vomiting 13 4 10 minutes

Constipation 12 6 15 minutes

Diarrhea 20 7 20 minutes

Radiation dermatitis 20 4 30 minutes



to administration of chemotherapy using the intravenouspiggy back method of administration is shown in Figure 4.

In total, eight nurses attended the train-the-trainer edu-cational sessions and gained approval to function ascompetency assessors. Somenurses served as competencyassessors at multiple community sites. Immediately afterthe training sessions, participants were asked if the pro-gram was helpful and worthwhile. Each participant statedthat he/she had not only learned something but also feltmore confident about assessing fellow coworkers. Theoverall evaluation of the program was positive, and manyassessors were glad to have standardized tools to use forassessment and training.

To date, more than 40 infusion nurses from across allacademic and community-based sites have successfullycompleted direct observation competency validation.

FIGURE 2 List of competencies for infusion nurses.

FIGURE 3 Characteristics of competency assessors.



Competency validation is now conducted during orienta-tion for all newly hired infusion nurses and annually forall other nurses working in our oncology infusion centers.Retraining of competency assessors and training of newcompetency assessors will occur annually.

DISCUSSIONThere is no standard approach to developing and im-plementing programs to validate staff competences andcompetencies. The AONQC team considered all of thecomponents involved in developing and implementingequitable validation programs that would be suitable forassessing nurse competences and competencies acrossall Karmanos/McLaren sites. The first task was to cultivate

a groupof nursing and oncologynursing expertswhowereable to (a) understand competences and competenciesfrom a nursing practice frame of reference and (b) advo-cate for standardization of nursing care across a widevariety of practice situations (urban, rural, infusion center,office/clinic).

A next stepwas to identify competences and competen-cies relevant across settings, while recognizing that variabilityin the scope of services provided set limits on which com-petencies should be validated. Ultimately, the group selectedhigh-volume (commonly occurring) treatment-related sideeffects and practice situations that carried a high risk ofharm to oncology patients if not performed flawlessly. Itis expected that quality indicators will be used to measurethe impact of these programs on patient satisfaction and

FIGURE 4 Competency checklist for safe administration of chemotherapy via intravenous piggy back method.



FIGURE 4 (Continued)



safety. For example, we anticipate that comparablelevels of nurse competences across service sites will leadto comparable high levels of patient satisfaction withnursing education about treatment-related side effects(a nursing-sensitive indicator). Similarly, it is expectedthat comparable skills competencies will lead to compa-rable levels of safe practice across sites as shown by lowlevels of blood-borne infections and low incidences ofmedication errors.

The AONQC members recognized from the beginningof this effort that the quality of the competency validationprogram depended on the quality of the training providedto prospective skills assessors. Assessors not only must beproficient in the skills and behaviors to be validated butmust also be able to recognize competency in peers, doc-ument practice variations, and discreetly interrupt anyprocedures being performed incorrectly.When designatedpreceptors are not available, assessments may be com-pleted by qualified peers; therefore, selection and trainingare critical. By using a train-the-trainer approach, all asses-sors received the same level of education and validation toensure that the process used to assess staff competencieswas a rigorous one. Careful selection of educators to con-duct the train-the-trainer sessions was another importantconsideration. The person(s) doing the training needs sub-stantive understanding of the skills/tasks being validatedandmust understand how to educate assessors to correctlyvalidate the quality of staff performance. It is important forthe trainer to help prospective assessors become comfort-able with correcting staff before, after, and/or during skillsvalidation. Because most of the assessors validate skills ofcoworkers, there may be additional concerns related to‘‘correcting my peers’’ that must be worked through duringtrain-the-trainer sessions. These concerns were addressed(a) by dialoguing about specific concerns, (b) through roleplay, and (c) by presenting the trainee with a situationand then asking how they would handle the situation.Finally, it is important to remember that, once ‘‘trained,’’the competencies of the assessor must be revalidatedannually. This becomes yet another layer of the overallvalidation program.

The role of the unit/clinicmanager cannot be overlookedwhen developing and implementing competence and com-petency validation programs. Implementing a programthat allows the work of the unit/area to continue relativelyuninterrupted is vital. Critical questions need to be ad-dressed. Will nurses be taken out of staffing to completethe prescribed modules and how will that be managed?Are peer assessors to be included in staffing on the daysthey are assigned to validate competency? The questionof ‘‘who will cover my patients while I do this?’’ requiresstaff coordination and trust. Manager buy-in can make orbreak even the most well-considered validation program.Astute managers do not manage the validation process; in-

stead, they recognize the veracity of the program invaluablyaids theminassessing individual staffperformance. It is theman-ager’s role to articulate competence and competencyexpectations and establish consequences if expectationsare not met (Wright, 2005). At the same time, he/she mustremain sensitive to staff perceptions of power inequalitiesthat might arise if competences and competencies must beshown as a condition of continued employment (Cusack &Smith, 2010). The AONQC recognized nursing manage-ment as an important stakeholder in the overall validationprocess. Consequently, management was consulted earlyon to (a) review PowerPointA programs for relevance, (b) de-cide which staff members should participate in the train-the-trainer program, and (c) determinewhich skills competencieswere appropriate for their infusion nurses based on theservices provided. Some competency assessors were se-lected because they were willing to travel across sites tovalidate competencies of nurses working in small commu-nity settings.

TheAONQCemployed twoof themost commonlyusedmethods to validate competences and competencies,

Example of learning how to correct a peer.

Situation:

While observing a peer, you notice that she usesher hand to wave over the port area just cleanedwith chlorahexidine in effort to dry it faster.

Question #1. How would you correct this behavior?

Acceptable response #1: I would ask the registerednurse to step away from the patient. Once awayfrom the patient I would explain what I saw thatwas performed incorrectly and provide rationalefor the correct procedure.

Question #2: Why not correct the staff member atthe bedside?

Acceptable response #2: It is better to avoidcorrecting the staff member in front of the patientbecause this can erode confidence and trust.

Question #3: If the staff member was about tomake an error that would harm the patient, whatwould you do?

Acceptable response #3: I would step in and takeover but explain away from the patient why I didso. I would do this because the goals are to protectthe patient, correct the practice, and maintain con-fidence and trust.



which were tests and direct observation of daily work.Wright (2005) identifies 11 different methods for verifyingcompetences and competencies and suggests that the useof a variety of techniques builds adult learning. Returndemonstrations, presentations, and mock surveys are justa few of the methods that can be used. In the future, theAONQC will explore use of different validation methodsto enhance program development and capture employeeinterest. It is expected that, with leadership support, theAONQCwill be able to foster an environment inwhich staffvalue and become accountable for maintaining their com-petences and competencies.

The sustainability of this initiative cannot be assured in avolatile healthcare economy. The greatest costs incurredfrom this initiative are the costs associated with removingassessors from the staffing plan to validate staff perfor-mance. One can argue that ensuring a highly skilled staffis an important and cost-effective preventative measurethat lowers the risk of costly medical errors. The AONQChas addressed some concerns about sustainability by inves-tigating alternative strategies for validating competencies;for example, by using a biannual validation schedule to de-crease the frequency of assessments. Sustainability willdepend, in part, on having strong local and regional cham-pionswho are able to communicate the value of the programto administrators and peers.

CONCLUSIONThe work reported here represents a first step in theAONQC’s effort to develop and implement processes forstandardizing nursing practice across diverse, indepen-dently functioning, ambulatory oncology settings. Thisearly effort was bifocal in that it was directed at validatingboth competences and competencies. One validationprogram was designed and implemented to assess thecompetences needed to develop systems of care to detecttreatment-related side effects and to help patients learn self-management of treatment-related side effects. A secondvalidation program was developed to assess competenciesneeded to prevent harm to oncology patients. This earlywork has laid a foundation for the ongoing development ofAONQC initiatives related to the quality and standardizationof oncology nursing practice across multiple geographicallydistant service sites of the organization. The AONQC hasno legitimate authority within the hierarchical structure ofthe organization. Nevertheless, it has a substantial powerbase because of the level of its members’ nursing andoncology expertise and because of its position as the onlycorporate body dedicated to ensuring the quality ofoncology nursing care across all ambulatory corporateentities. Moreover, the quality of the work produced haslegitimatized the AONQC as an expert panel committed toelevating the quality of oncology nursing care across allcorporate entities.

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Standardizing Assessment of - CEConnection · Standardizing Assessment of Competences and Competencies of Oncology Nurses Working in Ambulatory Care Clara Beaver, MSN, RN, AOCNS,