This question is asked by members, nonmembers, and non-nurse practice administrators. Our colleagues at the Association of Community Cancer Centers also see their members raise this topic, and it’s not unique to oncology nursing.

In the absence of a federal law, several states have passed legislation that addresses nurse staffing. Federal regulation only requires that “the nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed.”

How to determine an adequate number of nurses has been an elusive process. We hear from members that acuity tools, which were thought to be an answer, are often inadequate in capturing the experience of caring for patients with cancer.

In 2000, ONS conducted a comprehensive survey of oncology nurses, nurse executives, and oncologists to capture the perceptions of the nursing workforce environment and adequacy of staffing. This was a time of concern about a nursing shortage and decline in dedicated oncology units. One finding at the time was the migration of inpatient nurses to the outpatient environment because more treatment was moving to that venue. Little has been done to determine best practice for staffing in the outpatient environment. Reports from this research can be found in the Oncology Nursing Forum.

Recently, the American Nurses Association released a report, Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes. We have learned so much more since 2000 about the impact that staffing can make on patient outcomes, but our models to determine staffing have not changed much since then. ANA’s work on this is welcomed, and ONS has the opportunity to help members learn how to manage staffing for optimal patient outcomes.

This is work we will be undertaking. It will involve you because we will need to learn how you are determining staffing in your workplace. We are only at the beginning of developing our approach to this issue, and we welcome your input. You can email me directly with your thoughts on this at