chelsea backler
Chelsea Backler, MSN, APRN, AGCNS-BC, AOCNS®, is an oncology clinical specialist for ONS in Pittsburgh, PA.

With evolving treatments and novel approaches to care, outpatient oncology practice has grown exponentially during the past two decades. As a vital stop on the cancer journey for many patients, ambulatory clinics have seen a boom in acuity, patient needs, and staffing demands. ONS has been actively researching the growing staffing dilemma in ambulatory oncology nursing to help institutions understand and address nurse-patient staffing and which best practices can accommodate the varied challenges.  

After evaluating considerable feedback from ONS members around the country, the Society launched a focused literature review in 2017 to better understand the current state of ambulatory staffing. From that initial effort, ONS published two articles, “What Is ONS’s Perspective on the Ambulatory Staffing Dilemma?” in ONS Voice and “Member Input: The Challenge of Staffing in Ambulatory Infusion Settings” in the Clinical Journal of Oncology Nursing, to highlight the findings and ONS’s ongoing commitment to identifying a solution. Focus groups were held during the 2019 ONS 44th Annual Congress in Anaheim, CA, to glean further information about adequate ambulatory staffing in practice and how members can address challenges in practice.  

Member feedback is a vital component of ONS’s work, informing the Society’s efforts to develop solutions and guidance for ambulatory staffing levels, and it clearly showed that ambulatory staffing issues in oncology are just as complex as treatments and care. Despite extremely varied conditions, some common themes emerged, including time constraints on nurses in practice, complexity of treatment protocols, a limited number of staff on hand to address challenges, and the increasing level of nurse burnout in the ambulatory setting.  

Together, we can address unsafe staffing levels in ambulatory oncology nursing and ensure that better practices make an impact on our patients tomorrow, next month, next year, and beyond.

matt hays
Matthew Hays is the lead project manager for ONS in Pittsburgh, PA.

ONS developed its Position on Staffing of Ambulatory Treatment Centers to help inform staffing discussions at outpatient treatment centers. Although the statement is the result of ONS’s initial work in ambulatory staffing, it is by no means the end of the issue. Rather, it’s a jumping off point to continue the discussion and further engage membership on the issue. 

The collaborative aspect of this work has been crucial to ONS’s success: We want to hear stories from members who work in ambulatory clinics and have experienced staffing shortages. Getting involved in ONS’s work drives change, bringing better staffing practices to ambulatory clinics and helping to keep patients and providers safe. If your clinic has implemented a successful staffing strategy, consider sharing your team’s work in an article for CJON, as a presentation at ONS Congress, or on the ONS communities at 

Change never happens in a vacuum. Together, we can address unsafe staffing levels in ambulatory oncology nursing and ensure that better practices make an impact on our patients tomorrow, next month, next year, and beyond.  

To learn more about ONS’s work or get involved, members can visit the ONS communities or contact the clinical helpdesk at