The Cleveland Clinic Taussig Cancer Institute

The Expanding Role of APNs and NPs

Iyaad Hasan, CNP, APN/PA Director at the Cleveland Clinic Taussig Cancer Institute, is involved with the Community Outreach Program. Outreach services include screening and education about cancer prevention and risk factors.

The Taussig Cancer Institute at the Cleveland Clinic in Ohio employs more than 250 highly skilled doctors, nurses, and other healthcare professionals who provide advanced cancer care to more than 14,000 patients with cancer each year. The Taussig Cancer Institute is involved in translational research and clinical trials and collaborates internationally with other centers to ensure that patients have access to the latest advances in cancer treatment. Taussig is committed to providing a range of support programs to help patients navigate their treatment course and associated issues.

The Oncology Nurse-APN/PA spoke with Iyaad Hasan, CNP, who wears several hats at the Taussig Cancer Institute in his position as APN/PA Director.

Can you describe your role at Taussig?

Iyaad Hasan (IH): I have administrative and clinical duties. There are over 40 APNs [advanced practice nurses] and PAs [physician assistants] who work at Taussig Cancer Institute. My role is to make sure they are credentialed, productive, but are supported by me to help develop their career as an APN.

On the clinical side, I direct the Tobacco Cessation Program with Taussig. Smokers have more treatment-related complications, and smoking reduces the success rates of treatments by 40%. Our main goal in getting patients to stop smoking tobacco is to maintain high clinical outcomes and lower readmission rates. The program focuses on giving the patient the best chances of success through behavior modification strategies and providing pharmacology intervention.

I am currently involved in an effort to develop and expand our survivorship services beyond our excellent program for breast cancer patients. Taussig wants to offer survivorship programs to patients with head and neck cancer, colorectal cancer, and prostate cancer—3 cancer types with many survivors. Our vision is to have survivorship services for every type of cancer, including late-stage or metastatic disease patients, who are often ignored because they have a short life expectancy.

One great initiative that I am part of is our Community Outreach Program. Once a week I work with our Langston Hughes Center that serves the uninsured or underserved. At the clinic, I screen and educate patients on cancer risk factors and prevention. If a patient needs a cancer screening test, I refer him or her to our Taussig Cancer Navigation Program to work with them to obtain free or affordable screenings.

What is your greatest challenge?

IH: My biggest challenge is maximizing the scope of practice of the APNs within Taussig. As we move into healthcare reform, the role of the APN will increase. The Affordable Care Act will provide more opportunity for Americans to get health and cancer screenings. Thus, more cancers will be identified, which will drive up the patient volume. In addition, a shortage of oncologists is projected over the next decade. Both of these factors pre-sent a good opportunity for APNs to expand their roles in oncology clinical care. Although patients and physicians are becoming more exposed to APNs, they still do not understand their function and roles. This leaves many APNs not practicing within their scope and not stratified with their positions. So my constant challenge is to continue to ensure that APNs are practicing within their scope. I feel that the situation regarding APNs will change with more education and engagement by healthcare facilities, but for now, it is a constant challenge.

What are you excited about in the field of oncology right now?

IH: The advent of better understanding of the molecular basis of cancer cells and disease has led to greater success rates of cancer treatment, especially in the delivery of oral chemotherapies. Oral chemotherapy agents have fewer side effects, and patients can take the medication in the comfort of their home. Drugs like Gleevec, Cytoxan, and Xeloda have changed the way therapy is delivered. Although I am excited, I feel that nursing will have to take the lead in increasing patient adherence to these medications.

How has the role of the oncology nurse practitioner changed in the past 5 years?

IH: As previously stated, the projected shortage of oncologists has opened the eyes of a lot of healthcare professionals, and the scope of NPs is expanding in oncology. Physicians and the healthcare industry in general have a better appreciation of the potential of our value. APNs’ scope and formularies have increased, our research findings have been published, and there has been better reimbursement from third-party payers. These are all indicators of increased awareness and acceptance of APNs. It is an exciting time to be an oncology NP, especially with the new healthcare reform.

What inspired you to become an oncology NP?

IH: I was attracted to this profession because of the emphasis on health promotion and disease prevention. NPs have moved to an autonomous role as providers of patient care. We can help shape patients’ decisions to improve their health as well as educate them on cancer prevention and screening.

What advice would you give to someone just entering the profession?

IH: Many people in this field are ambitious and want to rush to show their potential as an independent provider. My main advice would be to take it slow and try to learn about the cancers, but most of all, hone in to learning how to manage the whole patient. Try to look at the overall health of a patient and help meet that patient’s needs. Cancer is not the only factor that affects a person’s general health.

What would you be if you weren’t an oncology NP?

IH: I would do international work on health promotion and disease prevention. Patients all over the world, especially cancer patients, need empowerment and education on maintaining optimal health. NPs are in the perfect spot to take care of teaching patients how to help themselves.