How to Transition New Nurse Practitioners to Oncology

Peer mentorship and dedicated clinical training can help transition nurse practitioners to the oncology space.

Nurse practitioners should receive comprehensive training when transitioning to roles in oncology, said Heather Jackson, PhD, FNP-BC, NEA-BC, FAANP, who helped spearhead a fellowship program to facilitate this shift for clinicians in this position.

Jackson, the administrative director of Advanced Practice at Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, explained in an interview with Oncology Nursing News that nurse practitioners who work in oncology enter the field at a deficit compared with physicians, who receive training in their specialty before entering that practice. Nurse practitioners, Jackson pointed out, may not have even gotten the chance to work in oncology as a nurse when pursuing the field.

Along with Karen Hande, PhD, DNP, ANP-BC, CNE, FAANP, ANEF, Jackson co-authored a study investigating the use of a fellowship program to usher nurse practitioners into a career in oncology. The fellowship includes an onboarding period, followed by clinical training with set goals, and includes a peer mentorship program where experienced advanced practice providers (APPs) act as a sounding board and provide newer practitioners with opportunities for professional growth, such as participating in research.

Jackson expanded on the need for oncology training for nurse practitioners in a conversation with Oncology Nursing News.

Oncology Nursing News: Why is it important that nurse practitioners are exposed to specialty-specific training?

Jackson: There is no foundational education for nurse practitioners, especially in hematology oncology. For instance, I’m a family nurse practitioner. I had lots of clinical hours in a family practice setting. I was even able to work in some specialty roles, but oftentimes we are not even given the opportunity to shadow and have clinical experiences in the hematology oncology setting. That’s different than a physician, who has a fellowship in that specialty training. They have 4 years of medical school, then they go on and they have exposure within a specialty.

We often have new graduates that come in who have a passion for cancer but maybe couldn’t experience oncology as a nurse, but they want a career in oncology. We are charged with having to onboard and make sure that that APP is successful.

In what way does a fellowship program alleviate the burden of educating nurse practitioners with little to no experience in oncology?

Think about all the subspecialties in cancer: surgical oncology, radiation oncology, stem cell transplant, malignant hematology, benign hematology. It is a whole world that I’ve certainly learned as I’ve come into it as a leader. Then, as a leader, I want to make sure that whoever I hire is successful. We have to get them plugged in with professional organizations. We also know that the distress of learning creates a psychological impact and stressor: How do I transition into a specialty provider? It’s a lot to process, and it’s been great to be able to do this research with Hande and be able to put recommendations out there for how to support and facilitate this career path.

What recommendations do you and Hande make for facilitating this transition?

As lead author, Hande led our grounded theory that walks through the mental and psychological process of how one progresses on that career path of novice, leading into being a full-on independent practitioner. Support for that comes from making sure you have a strong onboarding program. For anyone who is going into this practice, it should be made sure that there’s a solid, foundational onboarding program. We have one established over usually a 3-month period.

Then it transitions from the overseeing of clinical competency, making sure that there are certain goals and objectives that are being met every week to 2 weeks into a mentorship relationship, which is the value to having a veteran APP as a resource and professional reference that can guide practice and make sure that the nurse practitioner is getting plugged into in their professional development and participating in abstracts and research and those sorts of things.

What does the future of this professional transition look like?

While I love fellowships, what I found as a leader is that I couldn’t put everyone through a fellowship. Financially, there wasn’t an opportunity to be able to spend a year with every APP that I hired. I worked with Hande on what a theoretically informed framework could be. We use the grounded theory that Hande developed, and we applied that to a real framework.

The future is to have a framework to follow to make sure we’re keeping in mind the psychological impact, what the transition process is like, and that we’re giving that psychological support, as well as all the physical resources. I would hope that enterprises would recognize the value of that investment and look at the retention, burnout prevention, and then ultimately, the success of the clinician.

What should all nurses and APPs take away from this conversation?

Own your own professional development. No one knows more than yourself of what your learning needs are and how you best learn. Keep in mind that we are professional learners. Our education doesn’t stop; it’s a day-to-day process. I’m continually learning about new drugs and management that I can utilize for my patients.

That’s how we stay on top, and become the best of our profession. Always invest in learning, always look for opportunities, and always ask questions of how things could get better, or if you see an opportunity for improvement, ask, “Why aren't we doing that?”

This transcript has been edited for clarity and conciseness.