Transforming Oncology Nurse Education Through Fellowship Programs

Goals of the oncology nurse fellowship included decreasing turnover rates, increasing confidence, and fostering professional development.

In the complex and ever-evolving field of oncology, nurses must possess a strong foundation of knowledge, confidence, and critical thinking skills to deliver high-quality and evidence-based patient care. However, most nursing students receive limited or no exposure to oncology-related content in the classroom or clinical rotations.¹ As an oncology nursing professional development specialist, I noticed a trend among newly hired nurses in our organization. Despite their enthusiasm and passion for the oncology field, nurses new to oncology experienced elevated first-year turnover rates, signaling a need for enhanced onboarding and supportive educational strategies.

To address these challenges, I spearheaded the development of an oncology nurse fellowship program aimed at improving retention, confidence, and competence among new-to-specialty registered nurses (NTS-RNs). The fellowship has demonstrated promising results.

Background and Significance

The need for robust onboarding programs in oncology nursing is well documented. Oncology is a specialty that demands a deep understanding of complex pathophysiology, rapidly evolving treatment modalities, and thoughtful patient care approaches within the multidisciplinary team. NTS-RNs often face a steep learning curve that can lead to frustration, burnout, and, ultimately, turnover.^2,3 Within my institution, postorientation evaluations consistently revealed challenges in mastering oncology-specific nursing competencies, suggesting a gap in traditional onboarding methods.

Program Design

The Oncology Nurse Fellowship program was created as a quality improvement initiative to address the high turnover rates among NTS-RNs and to equip them with the tools needed for success in oncology nursing. Key objectives include the following:

1. Decrease overall turnover rates
2. Increase learner confidence and competence within the oncology nurse generalist competencies
3. Foster professional development in oncology nursing practice

The fellowship is structured into 4 sessions, each lasting 4 to 6 hours, spaced throughout the year. This schedule is designed to allow participants to digest and apply new information without feeling overwhelmed. Leader support at the front end is crucial to ensure the nurse has protected professional development time and isn’t pulled into staffing the day of class. Sessions build on prior knowledge and clinical experience, promoting continuous learning and progression.

A hallmark of the program is the emphasis on mentorship and peer support. Participants are assigned to cohorts intended to foster a sense of community and enculturation into the organization. We begin each meeting with a debrief and check-in to create a safe space for reflection and discussion.

Using the Oncology Nursing Society (ONS) nurse generalist competencies as a road map, we developed a comprehensive curriculum designed to give the novice oncology nurse a well-rounded foundation of knowledge.⁴ The first 2 sessions provide an overview of cancer as a disease, genomics, treatment modalities, symptom management, and oncologic emergencies. At 6 months, patient-centered care approaches are discussed among a multidisciplinary team with topics such as nutrition, financial toxicity, sexuality, oncofertility, palliative care, and survivorship. The final session focuses on professional development opportunities to encourage lifelong learning.

The program centers around a longitudinal case study that fellows present to their cohort. Participants select a patient with newly diagnosed cancer in their practice setting to follow via chart review for the year. Nurse fellows present the patient’s case and provide updates each time the group meets to explore complexities among the continuum of care. This experiential learning approach encourages critical thinking and reflective practice, which are crucial in delivering comprehensive oncology care.

Oncology certification review questions are embedded throughout the program utilizing gamification. Winners are given prizes they may select from, and fellows report increased learner engagement and retention of key concepts. Incorporating practice questions reinforces topics already covered and exposes them to the types of questions they can expect to see on the certification exam.

Each cohort concludes with a graduation reception that senior and local nurse leaders attend. Participants receive a framed certificate of completion and a lapel pin to proudly wear on their badge. Celebrating these milestones is essential, as recognition not only boosts motivation and engagement but also plays a key role in enhancing nurse retention.⁵

Results and Impact

Since its launch in November 2023, 7 cohorts have onboarded, with 50 total participants. After initial success with the pilot cohort, NTS-RNs from the inpatient oncology units have been incorporated. The blended audience from inpatient and outpatient practice settings has enriched discussions, fostered interdepartmental collaboration and problem-solving, and helped participants see the “bigger picture.” For example, nurses from the inpatient stem cell transplant unit, whose patients are typically very sick and may have relapsed or refractory disease, hear about the patients doing well and achieving remission from their colleagues in the outpatient world.

Confidence is measured among each of the ONS nurse generalist competencies using a 4-point rating scale. The surveys are administered at baseline and routinely throughout the program and beyond. Results show an increase in self-reported confidence among each of the competency domains: teamwork, clinical care, finance, quality, and professional development. Additional ONS competencies are available for clinical research nurses, nurse navigators, and nurse practitioners for institutions considering implementation of a fellowship program.

After participants complete the program, we continue to offer mentorship and leadership development beyond their first year. Many graduates have gone on to serve as preceptors for incoming nurses joining the fellowship. Some have advanced in our clinical ladder program and accepted formal leadership positions, whereas several are currently preparing for oncology certification. It has been incredibly rewarding to witness that initial spark of curiosity grow within each fellow as they navigate their unique journey into the oncology nursing practice.

Value of the Program

The Oncology Nurse Fellowship program has demonstrated its ability to enhance recruitment, retention, confidence, and professional development among NTS-RNs. Its success underscores the importance of structured onboarding programs in oncology, where nurses must navigate complex care environments and rapidly evolving treatment paradigms.

As oncology care continues to grow in complexity, investing in the education and professional development of all team members—RNs and advanced practice providers alike—is paramount. Fellowship programs represent a powerful strategy for fueling passion and igniting excellence across oncology care teams, ensuring patients receive the highest quality and evidence-based care from health care providers equipped to thrive in the demanding specialty of oncology.

References

1. Fox C. Why our undergraduate nursing programs need oncology content: reflections of a nursing instructor. Can Oncol Nurs J. 2020;30(1):62-63.
2. Diaz B, Corbett A, Camiling-Burke A. Blood and marrow transplantation RN fellowship: design, outcomes, and facilitating transition to practice. Clin J Oncol Nurs. 2018;22(6):673-675. doi:10.1188/18.CJON.673-675
3. Luttrell J, Sumner S, Ricafrente EMA, Saria MG. Beyond the chemotherapy certificate: building a knowledge base virtually for oncology nursing practice across a health system. Clin J Oncol Nurs. 2021;25(4):465-469. doi:10.1188/21.CJON.465-469
4. Gaguski ME, George K, Bruce S, et al. Oncology Nurse Generalist Competencies. Oncology Nursing Society. Accessed July 25, 2025. https://www.ons.org/sites/default/files/2023-06/Oncology_Nurse_Generalist_Competencies_2016%20_%20WebViewer.pdf
5. Rivera RR. Shelley AN. Engaging the nursing workforce: the KINDER framework for nurse leaders. Nurse Lead. 2025;23(4). doi:10.1016/j.mnl.2025.102444