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What is the Role for NP or PA in Oncology and BMT?

Posted on June 9, 2020   |   by   |   Leadership Skills APPs

What is the Role for NP or PA in Oncology and BMT?
Author Jill Gilliland

 Oncology, Bone Marrow Transplant (BMT), and Stem Cell Transplant (SCT) NPs and PAs may provide primary, acute or tertiary care in a variety of medical settings including hospitals, cancer care centers, private practice and palliative care centers.[1] They may also provide Oncology specific psych services (require PMHNP certification) or work in nontraditional settings delivering educational programs on cancer prevention and similar topics.

According to the Oncology Nursing Society, “PNPs/PAs provide a wide variety of care throughout the cancer continuum in hospital-, community-, or office-based oncology settings because of their clinical role in patients with cancer. Clinically, NPs are often seen as the initial, go-to provider for questions or concerns related to patient care, including performing patient triage, evaluating new and follow-up patients, ordering and interpreting diagnostic tests, interacting and communicating with multidisciplinary teams, supervising chemotherapy and biotherapy administration, prescribing medications, handling adverse events, and providing symptom management. NPs communicate with physicians about patients’ care plans and then work with the nursing staff and healthcare team to ensure that those plans are implemented.”[2]

Roles:

PMHNP – Psych Mental Health Nurse Practitioner certification PMHNP (growing role)

NP PC- Primary Care Pediatric/ Adult Nurse Practitioner – Ambulatory Providers

NP AC- Acute Care Pediatric/Adult Nurse Practitioner – Inpatient or high acuity outpatient providers (not required in all states but recommended) 

PA- Physician Assistant with experience in either Oncology, Bone Marrow Transplant (BMT), or Stem Cell Transplant (SCT)

PA First Assist- Physician Assistant with experience in working as a first assistant in cancer surgery. 

 

Scope of Practice by State and Role

Supervision Requirements for NPs/PAs

State law: Before full independent practice authority, an NP must have a regulated relationship with a physician for prescribing Schedule II controlled substances for 2,000 hours or two years.

 

Prescriptive Authority for NPs/PAs

An NP may prescribe controlled substances if they are within the NP’s scope of practice. The NP must pass an exam administered by the State Board of Nursing and must receive certification from State Board of Pharmacy

 

Additional Certifications:

APHON Certification: Association Paediatric Hematology/Oncology  Nurses -Pediatric Chemotherapy and Biotherapy Provider Program.

ONCC Certification: Advanced Oncology Certified Nurse Practitioner

What NPs/PAs can do:

 

Conduct H/PsManage clinical emergencies
Develop differential diagnosisPrescriptive authority
Assign a diagnosisBill independently
Perform invasive proceduresHold a DEA certificate
Order diagnostic tests and therapiesParticipate in quality/safety activities
Interpret and evaluate tests and therapiesParticipate in organizational research
Coordinate care and delegate appropriatelyServe on organizational committees
Provide consultationTeach interprofessional teams
Counsel patients and familiesServices are billable by the organization
Initiate referralsDocument in the medical record

 

  • Develop new clinical initiatives to improve overall patient care and flow for oncology and BMT.  
  • Order cancer drug therapies and supportive therapies. 
  • Serve as a consultant to the interdisciplinary team members in developing and revising treatment plans for patients with cancer admitted in the acute inpatient medical areas.
  • Provide oncology education for patients and their families, as well as pre-treatment counseling including discussion of potential alternative treatments.
  • Chemotherapy infusion
  • Provides care to patients following both autologous and allogeneic stem cell transplants
  • Us evidence-based literature and works toward evidence-based practice to effect a positive change in the health and healthcare delivered to the patient with a past, current, or potential diagnosis of cancer.

Oncology, BMT, SCT NP and PA Leadership and Other Roles:

In addition to a clinically based role, NPs/PAs may also serve as a mentor or preceptor, educate staff and patients, or work in faculty roles. They may also work on quality improvement projects or contribute to the research process. They may also provide Advanced Practice Provider (APP – PNPs and PAs) Leadership.  Many APPs have roles in organizations such as Chief Advanced Practice Officer (CAPO, at 100% Administrative time), Director of Advanced Practice (80-100% Administrative time), Manager or Supervisor of Advanced Practice (40-60% Administrative time), or Lead of Advanced Practice (20-30% Administrative time).  APP leaders provide the recruitment, retention, support, structure, processes, and economic models for building and growing APP teams. 

Oncology NP and PA Salaries: 

Assuming full benefits (Central US- Add approximately 22-40% more for the West Coast and NY and subtract approximately 8% for the Northeast and Southeast)

Provider Salary Range: [3]

Add approximately $2,000 – $3,000 for each year of experience. If a new grad NP is hired consider adding salary for RN experience at a rate of 2 years of RN experience is equivalent to 1 year as a NP with a cap of 5 years of NP experience. 

Average: $120000

Range: $100,000- 135,000 (PA First Assist and PMHNPs max is closer to $175,000)

Leadership NP and PA Salary Range:

Lead additional 5%

Manager additional 10%

Director additional 15% plus bonus

Schedules for NPs and PAs in Oncology and BMT/SCT inpatient and outpatient roles:

M-F 8 hour days:  Salaries approximated above

M-Sun and some evenings -8 hour shifts: Salaries approximated above plus additional $2,000- $3,000

24/7- 12 hour shifts approximated above plus additional $4,000-$6,000

The following are Recommendations for an Orientation for NPs and PAs:

Orientation is an important part of the hiring process and role satisfaction.  Most candidates leave within the first 2 years because of dissatisfaction with the role which starts with a supportive orientation.  New grad NPs and PAs, although well educated in the role, need specific orientation in the specialty practice area where they work.  Here is a list of the essential components of the orientation:

  • “Mentor” – ideally a NP or Physician from a different department.
  • Socialization with peers 
  • Assessment every 1-2 weeks to include feedback, personal goals, communication, evaluation, competency list, and clear path to essential process for  improvement.
  • Team understanding of the PA/NP job description, scope of practice and role expectations.
  • Provide introduction to key decision makers and locate resources.
  • Provide a preceptor with clear expectations, goals, competency and oversight.  Can rotate between people. Needs to be a MD or other NP/PA
  • Skill development and procedural training.
  • Provide 10% Professional time: study, research, didactic time
  • Time frame: 3-6 months depending on acuity (up to 12 months for a PA) New Grads (or less than 2 years of experience, can modify for someone with 1 year of experience), for experienced, Minimum 3 weeks.  This is appropriate for anyone with more than 2 years of experience in the same role. 
  • Caseload: Initial minimum caseload of 10-20%-patients for a novice

Resources:

  1. https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/oncology-nurse-practitioner/#:~:text=The%20duties%20of%20an%20oncology,through%20all%20stages%20of%20treatment.
  2. https://voice.ons.org/news-and-views/nurse-practitioners-enhance-the-oncology-workforce
  3. Melnic 2020 APRN and PA Free Salary Guide: https://www.melnic.com/advanced-practice-salary-guide/take-survey/

For NP or PA Oncology, BMT, or SCT jobs, visit Jobs.Melnic.com.  For help building an NP/PA Oncology, BMT, or SCT team, please contact Jill Gilliland, President, Melnic, jill@melnic.com Jill partners with organizations throughout the US to build and grow APP Oncology teams. 

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