The Role of the Nurse Practitioner in an Ambulatory Oncology Setting

Presentation Transcript

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

Oncology Nurse Practitioner

Camino Medical Group

Assistant Clinical Faculty, UCSF

Dept of Physiological Nursing

An idea that is starting to change practice
NP’s firmly established in primary care and women’s health; specialty NP’s have grown in numbers over the last ten years
Many NPs are adult or family NPs; once trained they get additional training in specialty areas
There are 23 specialty NP educational programs presently in the US

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

Nursing model used as primary training; medical classes serve as adjunct

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

Nursing Board oversees NPs

NPs need to have a collaborating physician, but may practice independently

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

PA can come from many backgrounds

Medical model is used in PA training; trained in general medicine

State Board of Medical Licensure oversees PAs

All PAs must have an MD in a supervisory role

PA students have more hours of supervised clinical practice in training

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

In California, it is called “furnishing”
NPs are certified by all but six states to prescribe medications
In California, NPs now have the ability to write for Schedule II-V medications as of 2005
NPs are also certified by the ANCC and ONS (AOCNP)

Do my charts need to be signed by an MD? The nursing practice act does not require MD countersignature, but insurances may require it
How often do I update my standardized procedures? Frequently enough to ensure that patients are receiving appropriate care
Can an NP request and sign for drug samples? Yes
In my furnishing procedure, do I need to list the drugs and devices that can be furnished or may I use categories? The law requires the identification of the drugs and devices in standardized procedure or protocol. You may not use drug categories

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

Standardized procedures are the legal mechanism for registered nurses, nurse practitioners to perform functions which would otherwise be considered the practice of medicine
Provides the system with satisfactory evidence that the nurse meets the experience, training, and/or education requirements to perform the functions

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

Board of Registered Nursing

Practice Partner: private, academic, inpatient or outpatient
Administrative Partner: documentation and coding
Research Partner: enrolling patients, writing study protocols
Liaison: between nurses and physicians and patients and physicians
Triage Nurse: taking patient phone calls, seeing all walk-in patients, performing chair rounds in infusion room

See treatment patients while on chemotherapy; write orders for subsequent chemotherapy treatments
See walk-ins or sick calls
See stable follow-up cancer patients

Does NOT write initial chemotherapy orders or change chemotherapy orders independently (except for those established by protocol: example AI’s)
Patients with urgent problems or who appear unstable reported to MD