Nurses are in high demand. Since 2000, the nursing profession has grown so steadily that it’s outpaced the growth of the U.S. population. Over the past decade, 500,000 new RNs joined the ranks, an increase of 24%.
This is only the beginning: government analysts estimated that employment of new nurses would grow by 26% from 2010 to 2020, nearly double the average occupational growth. Projections are equally strong for nurses whose primary position is in oncology, who numbered at nearly 120,000 in 2008.
As healthcare systems look to curtail costs, outpatient oncology care centers such as same-day chemotherapy services will grow at faster-than-average rates. And although nurse practitioner-led urgent care centers are still an anomaly, they have already demonstrated a high value for patients, helping them to manage their cancer symptoms without admission to the emergency department or hospital. These clinics are a sign that health care is well on its way to relying more heavily on nursing expertise for foundational oncology care.
The message is clear: oncology nurses are in the spotlight.
Oncology Nurses Have Untapped Opportunities With Nursing Informatics
“Nurses, whether we want to believe it or not, have a lot to offer to the design and implementation process of electronic health records,” says Anne Ireland, MSN, RN, AOCN®, founding coordinator of the ONS Nursing Informatics Focus Group.
When Ireland, now clinical director of the solid tumor program at City of Hope, was introduced to the electronic health record (EHR) management process, she says she realized that nurses not only knew the workflows but also understood the touchpoints—those areas where different nursing units had opportunities to work together and transform patient care.
“We are at a place where there is so much opportunity for us to ensure that EHRs are placed within the context of patient care,” Ireland says. “But sometimes we say, ‘I’m not a techie,’ and we put our heads down and wait for someone else to design our system.”
Ireland says that nurses can get comfortable using an EHR flowchart much sooner than a software consulting company can understand what it’s like to manage an inpatient unit with five patients, then build a system for it. Her conclusion? Nurses have to be at the table.
“We simply have to engage in the design process to get the content that we need,” she says. “Otherwise, we won’t have any nurses determining what nursing practice looks like at the EHR level.”
It’s more than an exercise in quality—it’s equally about documenting nursing’s value as a profession and demonstrating the relationship between nursing actions and patient outcomes. “The EHR is going to be the tool that determines the value that we actually bring to the patient experience,” Ireland explains. “We need to demonstrate that we improve patient outcomes, and that it is through our actions that people don’t fall or get things like central line infections and pressure ulcers.”
As a field, nursing informatics is young. It was first recognized as a specialty in 1992 by the American Nurses Association, with the first edition of Scope of Practice for Nursing Informatics published in 1994. It’s so young that only a handful of nursing schools have been able to integrate EHR technology training with their clinical observations or simulations.
“We have to be sure that we are preparing nurses who are not only clinically competent but who actually have a decent background in informatics, so they understand how to leverage the technology to support their clinical practice,” Ireland says.
Post-Secondary Education Is Expanding, With BSN as the Buzzword
According to the National Center for Health Workforce Analysis, 55% of nurses now have a bachelor’s degree or higher, with the BSN quickly advancing as the preferred educational foundation. The push comes on the heels of the Institute of Medicine’s (IOM’s) recommendation in its seminal 2011 report, The Future of Nursing: Leading Change, Advancing Health, that 80% of nurses earn their BSN by 2020.
“The ways in which nurses were educated in the 20th century are no longer adequate for dealing with the realities of health care in the 21st century. As patient needs and care environments have become more complex, nurses need to attain requisite competencies to deliver high-quality care.”
In its survey of 501 schools of nursing, the American Association of Colleges of Nursing (AACN) reported that 39.1% of employers require new hires to have their BSN, and 77.4% “are expressing a strong preference for BSN program graduates.” For discriminating applicants, BSN preferred may as well mean mandatory. However, employer preferences vary widely across the United States and may be less strict in regions with high nursing shortages.
“Given the difference among facilities and geography, it’s difficult to generalize,” says Heather Mackey, ONS Education project manager. “But in general, we’re starting to see most Magnet-designated facilities hiring only BSN graduates. Where there isn’t a determined preference, it’s possible that a few years of acute care experience in oncology may be more valuable than a BSN, especially if one obtains certification during that time.”
In 2003, a landmark study from the University of Pennsylvania School of Nursing reported that a higher proportion of BSN-prepared nurses could result in lower patient mortality rates and complications.
In 2005, the Veteran’s Administration (VA) instituted BSN-only policies for new hires and programs to assist current employees in obtaining one. As part of a larger effort by the Department of Veteran Affairs, the VA set aside $50 million to help thousands of VA nurses obtain a BSN or graduate-level nursing degree.
Legislators in New York and New Jersey have introduced “BSN-in-10” bills that would require nurses to complete their bachelor’s degree within 10 years of licensure. The North Shore-LIJ Health System in New York shortened that time span, announcing in 2010 that it was requiring all new hires to have a bachelor’s degree or to earn one in five years. Current employees were exempt from the requirements but were strongly encouraged to earn the degree through a special tuition reimbursement program.
If you’re currently pursuing your baccalaureate degree in nursing, you can apply for an ONS Foundation Bachelor’s in Nursing Degree scholarship. Applications are due February 1 of each year.
Most Nurses Find Their Path to Oncology on the Job
In 2013, ONS coauthored a survey of prelicensure nursing professors and found that they indicated major barriers to teaching oncology content, citing lack of time with competing curricular contents. The authors reported,
“Two BSN programs mentioned that cancer content was not viewed as a priority in a curriculum that was already concentrated with concepts required by accreditation bodies, the NCLEX-RN® test blueprint, and clinical specialty organizations. Some prelicensure RN programs reported that their main priority was to prepare ‘generalists’ rather than ‘specialists.’ Lack of access to oncology-related resources, such as clinical sites, patients diagnosed with cancer, or faculty with oncology expertise, comprised the next highest barriers faced by all program types.”
With its recent launch of the Educator Resource Center, a subscription portal with oncology curriculum materials, ONS is making strides to diminish the barriers to teaching cancer care. However, as many schools of nursing continue to hew closely to NCLEX-RN® concepts, on-the-job training in oncology dwarfs the reception of knowledge at the baccalaureate level.
More Nurses Pursue Oncology Nursing Certification
Reflecting both employees’ and employers’ desire to validate their professional expertise, the number of oncology-certified nurses has grown steadily since the inception of the first certification program in 1986. Certification continues to be a popular option for nurses seeking to differentiate themselves and step up the career ladder. For those seeking to make a career move geographically, it can also help to demonstrate that they have a nationally appraised body of knowledge.
For employers seeking the American Nurses Credentialing Center’s (ANCC’s) Magnet recognition, the educational preparation of their staff is especially critical. Of the ANCC’s “14 Forces of Magnetism,” used to help appraise healthcare workplaces, its Professional Development force looks for high-quality initiatives that support formal education and staff certification.
With the nation’s corresponding emphasis on advanced education and formalized education—not just in nursing care, but across all fields—continued growth in certification is expected in coming years.
| Credential | As of 1/1/2012 | As of 1/1/2013 |
| OCN® | 27,317 | 30,433 |
| CPHON® | 733 | 1,278 |
| AOCNP® | 871 | 1,088 |
| AOCNS® | 350 | 404 |
| CBCN® | 670 | 854 |
| *AOCN® | 1,001 | 945 |
| *CPON® | 1,713 | 1,496 |
*AOCN® and CPON® examinations are no longer administered and can be renewed only by nurses who already hold the credential.
The Workforce Ages But Welcomes Younger Nurses
With rapid growth in the number of new entrants, the number of nurses younger than 30 has increased. At the same time, approximately one-third of the nursing workplace is older than 50 and will near the standard retirement age in 10–15 years.
What does that mean for you? You’re in an excellent position to mentor or be mentored. If you haven’t already, get involved with your local ONS chapter. Chapter membership is now included in your ONS dues, and it’s the perfect way to find mentors or bring new nurses into the fold through dinner programs, special volunteer activities, and other educational programs. Visit the ONS website to find your nearest ONS chapter.