Patient Safety First: How a CNS Bridges Oncology Research and the Bedside

When a patient on a clinical trial deteriorates, bedside oncology nurses can feel caught between the protocol and the patient. For Leslie Smith, DNP, MSN, RN, APRN-CNS, BMTCN, AOCNS, the priority is clear.

“The emphasis is always on the patient and safety. Research never outweighs the clinical care of the patient,” Smith said on part 1 of an Onc Nurse On Call episode with Stephanie Desrosiers, DNP, MSN, RN, AOCNS, TCTCN, co-editor-in-chief of Oncology Nursing News and senior director of community-based ambulatory oncology nursing at UCLA Health.

Smith, a clinical nurse specialist (CNS) in oncology and stem cell transplant at a research hospital in Bethesda, Maryland, previously spent about 19 years as a staff nurse on an acute leukemia and lymphoma unit at The James Cancer Hospital at The Ohio State University.

Why Should Patient Safety Outrank the Protocol?

Putting the patient first can be hard for principal investigators (PIs) and for the bedside nurse “who really wants to do the right thing with implementing the protocol and feels caught between the PI and the clinical state of the patient. Should I call a rapid response? Should this patient go to the ICU?”

The CNS can mediate, Smith said, building consensus on an ICU transfer or a pause in study activity. “I think that’s one of the most important things I do,” she said.

How Can Protocol Review Expand Nursing Skills?

Smith reviews protocols before they reach the bedside. “So I look at, can nursing do this? Is it within our scope of practice?” she said.

The review can also open doors. “Well, it is within our scope. We’ve just never done it before,” Smith said. She cited reservoir taps and hepatic arterial pump access, new nursing skills the board of nursing approved years ago. “It’s an opportunity for nurses to advance their skills and knowledge and put something more on their CV.”

How Can Frontline Nurses Get Involved in Research?

Smith encourages nurses to “look at your practice. We all have questions, what if or why?” At her institution, those questions go to shared governance and evidence-based practice councils.

Those who want to lead studies can partner with nurse scientists. “I’m not a nurse scientist, even though I have a doctorate, but really statistics is not my area of expertise, I need help,” Smith said.

Protected time remains a barrier. “I think the challenge for a lot of nurses and managers is giving the nurse work time to be able to complete those projects,” she said. Desrosiers noted that support can be harder to find in community or rural hospitals. Previous Oncology Nursing News coverage has highlighted protocol pre-planning and interdisciplinary teamwork as central to research nursing.

What Are the Key Takeaways for Oncology Nurses?

• Patient safety outranks protocol adherence; the CNS can help the team reach consensus when a trial patient’s condition changes.
• Protocol review confirms scope of practice and can identify new nursing skills.
• Everyday practice questions can feed shared governance and evidence-based practice projects.
• Protected work time remains a key barrier.

References

1. Smith L. Interview with Stephanie Desrosiers. Onc Nurse On Call, part 1. Oncology Nursing News. 2026.

2. ONN Staff. The frontier of care: how oncology research nurses drive clinical excellence. Oncology Nursing News. June 23, 2026. Accessed October 20, 2026. https://www.oncnursingnews.com/view/the-frontier-of-care-how-oncology-research-nurses-drive-clinical-excellence