The ONS clinical inbox frequently receives questions about whether nurses need to be “chemotherapy certified” to give specific chemotherapy and/or biotherapy agents.

In this case, “certification” is a common misnomer. ONS does not have or endorse any program that results in being certified to administer chemotherapy. No didactic program or examination provides a nationally recognized certification for chemotherapy/biotherapy administration. ONS’s chemotherapy/biotherapy courses provide a chemotherapy certificate and a provider card for students who successfully complete all course requirements (see sidebar), but this is not the same as professional certification or licensure.

Because ONS is not a regulatory agency or accrediting body, we cannot mandate that any specific education, training, or certificate be required to administer these high-risk agents. Rather, we encourage that policies and procedures are developed at each individual practice clearly stating what education and clinical competence must be demonstrated prior to being able to engage in chemotherapy- or biotherapy-related procedures. Each institution or practice must determine how it will assess nursing competence in performing various chemotherapy-related skills (ONS, 2015; Polovich, Olsen, & LeFebvre, 2014). 

ONS’s (2015) standard is that RNs should complete didactic content regarding certain chemotherapy- and biotherapy-related principles, and then complete a clinical practicum under the auspices of the institution or supporting agency. Due to the high-risk nature of these agents, it is our position that this would apply to all chemotherapy and biotherapy agents regardless of dose, route, or indication for treatment.

Within the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (Polovich et al., 2014), is a chapter titled, “Competence in Chemotherapy Administration,” addressing both the didactic and clinical aspects of establishing competency. Annual competency renewal through clinical activities or simulation is recommended for all staff involved in chemotherapy or biotherapy administration. The book’s appendix provides an example of a clinical practicum evaluation that focuses on demonstrating proficiency in treatment administration skills as well as pre-treatment and post-treatment assessments.

Each institution or practice must determine how it will assess nursing competence in performing various chemotherapy-related skills.

Oncology Nursing Society (ONS). (2015). Education of the RN who administers and cares for the individual receiving chemotherapy and biotherapy [Position statement]. Retrieved from

Polovich, M., Olsen, M., & LeFebvre, K.B. (2014). ONS chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society.


Posted by Michele Moreho… (not verified) 3 months ago

Do most hospitals pay s differential for administering chemo? My place of employment does not. What is the standard nurse patient ratio inan acute care hospital oncology setting when administering chemo?

Posted by Gricelda Campos (not verified) 3 months ago

Yes my organization pays a premium to the nurses for administering chemo inpatient from day the pt. Receives the first dose up to 48 hours from the completion. The ratio is 3:1 when the nurse is administering chemo on a med surf/tele/oncology floor

Posted by Karen Kight (not verified) 3 months ago

My hospital does not pay a premium for chemo administration, however, it does pay for the ONS Chemotherapy/Biotherapy Provider course as long as the RN passes the course. All of our RN's go through this training on the Heme/Onc unit. Our RN:Patient ratio is 1:4 and we are a Progressive care level of unit.

Posted by Dana Driskill (not verified) 2 months 4 weeks ago

All we give is chemo so there is no difference in pay, but we reimburse for the Provider course because we require it. I see the RN:Pt ratio for inpatient, can anyone tell me the ratio in an outpatient setting?

Thank you all for your comments. Kathleen Wiley is one of the Oncology Clinical Specialists with ONS. She noticed your request for information about staffing an outpatient facility and provided the following information. ONS does not have any standards or guidelines related to staffing because of a lack of research in the area and the great variation in resources and census across practice sites. We do have some basic staffing information on our website at Unfortunately, ONS does not have any further benchmarking data than what is listed on the website for inpatient or ambulatory oncology units simply because it is not available. We do check frequently for new articles and information. For information about the ambulatory setting, we recommend consulting the ACCC, as staffing is addressed in Section 4 of the ACCC Cancer Program Standards (Oncology Nursing Services), developed for ambulatory oncology centers. Their website is For instance, a search on the ACCC site for “staffing” resulted in a long list of articles: that you may want to review.

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