The Role of the Nurse Practitioner in an Ambulatory Oncology Setting Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP Oncology Nurse Practitioner Camino

The Role of the Nurse The Role of the Nurse Practitioner in an Practitioner in an

Ambulatory Oncology Ambulatory Oncology SettingSetting

Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNPPamela Hallquist Viale, RN, MS, CS, ANP, AOCNP

Oncology Nurse PractitionerOncology Nurse Practitioner

Camino Medical GroupCamino Medical Group

Assistant Clinical Faculty, UCSFAssistant Clinical Faculty, UCSF

Dept of Physiological NursingDept of Physiological Nursing

Specialty Nurse Specialty Nurse PractitionersPractitioners

• An idea that is starting to change practiceAn idea that is starting to change practice• NP’s firmly established in primary care and NP’s firmly established in primary care and

women’s health; specialty NP’s have grown in women’s health; specialty NP’s have grown in numbers over the last ten yearsnumbers over the last ten years

• Many NPs are adult or family NPs; once trained Many NPs are adult or family NPs; once trained they get additional training in specialty areasthey get additional training in specialty areas

• There are 23 specialty NP educational There are 23 specialty NP educational programs presently in the USprograms presently in the US

Young, T (2005). Utilizing oncology nurse practitioners: a model strategy. Community Oncology, 2, 218-224.

Differences Between NP Differences Between NP and Physician’s Assistantand Physician’s Assistant

• NP must be a nurseNP must be a nurse• Nursing model used as Nursing model used as

primary training; medical primary training; medical classes serve as adjunctclasses serve as adjunct

• NPs are trained as specialists NPs are trained as specialists (adult, pediatrics, ect)(adult, pediatrics, ect)

• Nursing Board oversees NPsNursing Board oversees NPs• NPs need to have a NPs need to have a

collaborating physician, but collaborating physician, but may practice independentlymay practice independently

• All NPs are at the Master’s All NPs are at the Master’s level; as of 2015 this may level; as of 2015 this may change to doctorate level onlychange to doctorate level only

• PA can come from many PA can come from many backgroundsbackgrounds

• Medical model is used in PA Medical model is used in PA training; trained in general training; trained in general medicinemedicine

• State Board of Medical Licensure State Board of Medical Licensure oversees PAsoversees PAs

• All PAs must have an MD in a All PAs must have an MD in a supervisory rolesupervisory role

• PA students have more hours of PA students have more hours of supervised clinical practice in supervised clinical practice in trainingtraining

• PA can be at bachelor level; this PA can be at bachelor level; this will change to MS in 2006will change to MS in 2006


Prescriptive AuthorityPrescriptive Authority

• In California, it is called “furnishing”In California, it is called “furnishing”• NPs are certified by all but six states NPs are certified by all but six states

to prescribe medicationsto prescribe medications• In California, NPs now have the In California, NPs now have the

ability to write for Schedule II-V ability to write for Schedule II-V medications as of 2005medications as of 2005

• NPs are also certified by the ANCC NPs are also certified by the ANCC and ONS (AOCNP)and ONS (AOCNP)


Schedule II PrescribingSchedule II Prescribing

Frequently Asked Frequently Asked Questions Regarding NP Questions Regarding NP

PracticePractice• Do my charts need to be signed by an MD? The nursing Do my charts need to be signed by an MD? The nursing

practice act does not require MD countersignature, but practice act does not require MD countersignature, but insurances may require itinsurances may require it

• How often do I update my standardized procedures? How often do I update my standardized procedures? Frequently enough to ensure that patients are receiving Frequently enough to ensure that patients are receiving appropriate careappropriate care

• Can an NP request and sign for drug samples? YesCan an NP request and sign for drug samples? Yes• In my furnishing procedure, do I need to list the drugs In my furnishing procedure, do I need to list the drugs

and devices that can be furnished or may I use and devices that can be furnished or may I use categories? The law requires the identification of the categories? The law requires the identification of the drugs and devices in standardized procedure or drugs and devices in standardized procedure or protocol. You may not use drug categoriesprotocol. You may not use drug categories

Frequently Asked Questions Regarding NP practice (Revised 12/2004). Board of Registered Nursing, State of CaliforniaFrequently Asked Questions Regarding NP practice (Revised 12/2004). Board of Registered Nursing, State of California

Standardized ProceduresStandardized Procedures

• Standardized procedures are the legal Standardized procedures are the legal mechanism for registered nurses, nurse mechanism for registered nurses, nurse practitioners to perform functions which would practitioners to perform functions which would otherwise be considered the practice of otherwise be considered the practice of medicinemedicine

• Provides the system with satisfactory evidence Provides the system with satisfactory evidence that the nurse meets the experience, training, that the nurse meets the experience, training, and/or education requirements to perform the and/or education requirements to perform the functionsfunctions

An explanation of standardized procedure requirements for nurse practitioner practice (12/1998). An explanation of standardized procedure requirements for nurse practitioner practice (12/1998). Board of Registered NursingBoard of Registered Nursing

Roles of Oncology Nurse Roles of Oncology Nurse PractitionersPractitioners

• Practice Partner: private, academic, inpatient or Practice Partner: private, academic, inpatient or outpatientoutpatient

• Administrative Partner: documentation and Administrative Partner: documentation and codingcoding

• Research Partner: enrolling patients, writing Research Partner: enrolling patients, writing study protocolsstudy protocols

• Liaison: between nurses and physicians and Liaison: between nurses and physicians and patients and physicianspatients and physicians

• Triage Nurse: taking patient phone calls, seeing Triage Nurse: taking patient phone calls, seeing all walk-in patients, performing chair rounds in all walk-in patients, performing chair rounds in infusion roominfusion room


Example of NP Role in Oncology Example of NP Role in Oncology Ambulatory SettingAmbulatory Setting

• See treatment See treatment patients while on patients while on chemotherapy; write chemotherapy; write orders for orders for subsequent subsequent chemotherapy chemotherapy treatmentstreatments

• See walk-ins or sick See walk-ins or sick callscalls

• See stable follow-up See stable follow-up cancer patientscancer patients

Example of an NP Role in Example of an NP Role in the Ambulatory Settingthe Ambulatory Setting

• Does Does NOTNOT write initial write initial chemotherapy orders chemotherapy orders or change or change chemotherapy orders chemotherapy orders independently (except independently (except for those established for those established by protocol: example by protocol: example AI’s)AI’s)

• Patients with urgent Patients with urgent problems or who problems or who appear unstable appear unstable reported to MDreported to MD

Common Problems Common Problems Encountered in Encountered in

Ambulatory PracticeAmbulatory Practice• DVTDVT• Herpes ZosterHerpes Zoster• CAPCAP• Neutropenic FeverNeutropenic Fever• HSRHSR• AbscessAbscess• Diarrhea/Diarrhea/

ConstipationConstipation

• With standardized With standardized procedures/protocolsprocedures/protocols, NP’s can manage , NP’s can manage these and like these and like problems, bringing in problems, bringing in the MD when the MD when appropriateappropriate

Special Skills ONP’s Bring Special Skills ONP’s Bring to Oncology Settingto Oncology Setting

• Psychosocial CarePsychosocial Care• Patient EducationPatient Education• Performing ProceduresPerforming Procedures


Documents

The Role of the Nurse Practitioner in an Ambulatory Oncology Setting Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP Oncology Nurse Practitioner Camino