Oncology Clinical Nurse Specialists

Cyndi Miller Murphy, RN, MSN, CAE

Oncology Nursing Certification Corporation

Executive Director

Historical Perspective

1968 University of Pittsburgh offered an oncology tract in the medical-surgical master’s degree program in nursing

1974 First oncology graduate program in nursing offered at Rush University

1990 44 graduate programs in oncology nursing in USA

Historical Perspective1990 Oncology Nursing Society (ONS)

published the Standards of Advanced Practice in Oncology Nursing

– defined the structure, process, and outcome criteria for advanced practice nursing

Oncology Nursing Certification Corporation (ONCC) survey of ONS members with graduate education indicated that 69% were interested in obtaining advanced oncology certification

Historical Perspective1993-1994 First role delineation study

(RDS) of advanced clinical oncology nursing practice was conducted by ONCC• 1,349 master’s prepared ONS

members in clinical roles were surveyed

• Instrument based on the CNS role

• Responses CNS 58%

NP 6%

Other 36%

Historical Perspective

1995 First AOCN® Certification Examination Administered

First ONS Position Statement on Advanced Oncology Nursing Practice published

1997 ONS published Statement on the Scope and Standards of Advanced Practice in Oncology Nursing

Historical Perspective

1998 Second RDS of Advanced Oncology Nursing Practice conducted by ONCC

Significant shift in roles of Oncology APN

ONS Membership

CNS NP

1994 1660 269

1998 1417 633

Historical Perspective

1998 Second RDS of Advanced Oncology Nursing Practice

1200 Oncology APN surveyed1200 Oncology APN surveyed

1998 1994

NP 41% 6%

CNS 36% 58%

Combined 11%

Other 12% 36%

Historical Perspective

• Significant changes in practice from 1994

• Significant changes to the Test Blueprint

• Few significant differences were found between the NP and CNS groups with regard to knowledge and job responsibilities (< 10% items)

1998 RDS

Historical Perspective

1999 Revised AOCN® Certification Examination administered

Historical Perspective

2003 ONS Position on The Role of the Advanced Practice Nurse in Oncology Care revised

Third RDS of Advanced Oncology Nursing Practice conducted by ONCC

• Response to changing demographic

ONS Membership

CNS NP

1994 1660 269

1998 1417 633

2004 833 1283

Results of Third RDS

2003

Oncology CNS and Oncology NP share a substantial core of knowledge important to both roles. However, there are discernable differences in work responsibilities for NP and CNS in oncology.

Results of Third RDS

2003

Task-knowledge linkages were used to develop relative weights of the test specifications (blueprints) for separate role specific examinations.

AOCNS, AONP Test BlueprintsTopic Weight

I. Cancer Screening, Prevention, Early Detection, and Genetic Risk

II. Cancer Diagnosis and Staging

III. Cancer Treatment Modalities

IV. Acute, Chronic, and Late Symptom Management

V. Oncologic Emergencies

VI. Psychosocial Management

VII. Coordination of Multidisciplinary Care

VIII. Professional Practice

IX. End of Life Care

X. Research Utilization

X. Roles of the CNS

NP

4%

8%

20%

19%

12%

15%

5%

9%

5%

3%

CNS

4%

3%

14%

13%

11%

17%

9%

13%

5%

12%

2005

Administration of new AOCNS, AOCNP Certification Examinations

Care Setting

1994 1998 2003

In Patient 58% 34% 31%

Out Patient 37% 63% 61%

Home 5% 3% 1%

Other 7%

AOCN® Certified Nurses

NP 470

CNS 436

Administrator 196

Educator 133

Other 250

AOCN® Certification Recognized for CNS Role in 13 states

Specialization vs. Subspecialization

Oncology meets the ABNS definition of a specialty and all related ABNS standards

•Definition and Scope of Nursing Specialty

•Research Based Body of Knowledge

Specialization vs. Subspecialization

Specialty : Oncology

Examples of Subspecialties within oncology•Specific diseases or categories of diseases

LeukemiasGynecologic Cancers

CNS TumorsEndocrine Tumors

•Specific treatment entitiesBlood and Marrow TransplantationRadiation OncologySurgical Oncology