Advanced Practice Nurses Forge New Ground in Radiation Oncology Units

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BOSTON—Nurses have been involved in radiation oncology since the early 1940s, but as nursing roles in general have evolved over time, so has the role of these nurses. A group of advanced practice nurses (APNs) shared how they came to be part of their facility’s radiation oncology department and how the increased strain on healthcare is opening opportunities in this field for APNs.


The role of a RadOnc APN is multifaceted. They provide patient education, participate in consultations and treatment visits, administer follow-up care and symptom management, handle inpatient admissions, mentor staff, and participate in research.


Elene Viscosi-Spieler, APRN, BC, is a RadOnc nurse in the head and neck department at Massachusetts General Hospital (MGH) in Boston. “Nurse practitioners [NPs] are vital to the multidisciplinary team,” she said. “I am often the first person the patient sees.”


Viscosi-Spieler’s team includes radiation oncologists, residents and fellows, radiation registered nurses (RNs), therapists, physicians/dosimetrists, and research and administrative staff. Her input is sought on developing plans for treatment and follow-up care. As part of a multidisciplinary team, she attends tumor boards and new-patient conferences. “Once treatment is established, my role is one of a navigator, an educator for the patient and family, and a patient care provider to help them get through their symptoms.” She also makes appropriate referrals to other team members.


The greatest benefit in adding an APN/NP to the radiation oncology staff is their ability to manage adverse effects promptly and effectively. “There are many early toxicities as a result of radiation that have to be dealt with to avoid treatment interruptions,” Viscosi-Spieler explained. After therapy’s acute effects diminish, she watches for late effects and addresses quality-of-life concerns.


Diane Doyle, MS, APRN, BC, AOCN, is an NP at MGH who was at Boston’s Brigham and Women’s Hospital (BWH) in 2005 when it became one of the first institutions to incorporate NPs in radiation oncology. Realizing how effective NPs were in medical oncology, Doyle said it was a natural decision to use them in radiation oncology, starting with units whose patients need more intense symptom management because of cancer type or concomitant therapies.


At MGH, Doyle works with radiation patients with thoracic and central nervous system malignancies. Doyle said, “The physicians were a little hesitant at first, but they’ve come on board nicely.” Now every radiation oncology team wants an NP. MGH recently created a position for a palliative care NP in radiation oncology.


Doyle said APN/NPs in radiation oncology sometimes feel isolated from other NPs, and joked that it is not because they are locked away in the hospital basement all day. “There just aren’t that many of us out there,” she said. “Networking is important to bridge this isolation.”


Allison Taylor, MSN, APRN, BC, AOCNP, an NP affiliated with BWH, noted that the Oncology Nursing Society has a special interest group for radiation oncology nursing. She also praised the American Society for Therapeutic Radiology and Oncology for being supportive of NPs in this specialty.


Cost is a major obstacle to using APNs/NPs in radiation oncology or in small clinics such as the one Taylor has worked at for 4 years. “We are only able to bill right now for our follow-up visits,” said Taylor. “We cannot bill for status checks and outpatient or inpatient consultation or hospital admissions.” Her clinic collects a lump sum at the outset of treatment that incorporates the expense of the NP.


Another challenge is defining the role of the RadOnc APN/PN, broadly as a career and specifically for fellow nurses, physicians, and patients. Physicians might not understand the level of care an APN/PN is capable of furnishing, radiation RNs might fear that the APN/PN will replace them, and patients find it “hard to accept they aren’t seeing the physician at first,” said Taylor. “But [after that] they may want to see just you.” The radiation oncologist should explain to patients how the APN/NP fits into their care.


The speakers called for changes in American College of Radiology guidelines to reflect the growing involvement of NPs in caring for radiation oncology patients. Taylor said research is needed to assess the effects of APNs on the quality of patient care and healthcare costs.

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