BOSTON— Practices, community cancer centers, and hospitals are looking at supplementing physicians’ services with nurse practitioners (NPs), who can handle many aspects of care. This has been brought about by the deepening shortage of oncologists and increasing number of oncology patients, which has created a need for alternative models of care. To demonstrate how this model can work, Melanie Maze, RN, MSN, ANPBC, OCN, and Jean Treacy, APRN, BC, AOCNP, shared their experiences as NPs in oncology nursing from different sides of the spectrum. Maze works in the outpatient setting at Missouri Cancer Care in Lake Saint Louis, and Treacy belongs to an inpatient oncology NP unit at Massachusetts General Hospital in Boston.
At Missouri Cancer Care
Maze said oncology practices that hire NPs benefit in several ways, including financially. Patients also benefit, because on average NP visits last 30 minutes compared with 15 minutes for physicians. Maze said much of her visits are spent on education and symptom management. Her day comprises 4 hours providing direct patient care and 4 hours handling tasks such as triaging issues in the treatment room and discussing laboratory results.
Maze arrives at the office early and begins administering chemotherapy while the physicians are making their rounds. Her ability to prescribe medications and handle a range of patient concerns frees physicians up to take on new patients. “When you’re freeing a physician up to see new patients, they’re making money.” She also sees patients when the physicians are away, allowing the office to remain open all 52 weeks in the year. Since Maze was hired, staff overtime has declined, relieving stress and reducing overhead expenses, because the office now generally closes on time.
“If you look at independent billing versus incident-to billing, it won’t take long to see how soon you recoup your salary. After that, everything made is revenue for that practice,” said Maze. Within 6 months of starting, her practice hired another NP. “I was able to show them how valuable it was to the practice to have an NP.” Two physicians from the practice are retiring and will be replaced with 1 physician and 1 NP.
Maze, who has 27 years of oncology nursing experience, said her practice previously relied on primary care nurses, and it took time for her to gain everyone’s trust. “It was a learning curve…figuring out where I fit in.”
At Massachusetts General Hospital
For Treacy, the physicians were used to working with NPs and knew what NPs could handle. When the Accreditation Council for Graduate Medical Education recommended leaving 14 oncology beds uncovered to reduce demands on existing staff, the optimal solution was to create an NP oncology unit. The beds were split between medical oncology and thoracic oncology and staffed with 11 NPs who work 24 to 39 hours per week, and 3 per diem NPs are on the floor 24/7. All are supervised by a medical director and a nursing director, with an attending as primary backup. The team includes no interns or residents, although a medical senior is used to triage problems the NPs are not comfortable handling.
Treacy serves as the team’s permanent nighttime NP. “Our responsibilities are very similar to what the interns and residents do, but it’s how we do it that sets us apart.” The NPs serve as the responding clinician. They meet with families, order and interpret laboratory reports, order consults, and confer with specialists. “We are responsible for admitting as well as discharge, and we do documentation,” she said.
All the common admitting diagnoses are well within the nursing scope of care. “We try very hard to adhere to primary nursing from the NP standpoint, with a comprehensive, patient-centered approach to care.”
The model has decreased the length of hospitalization, saving the hospital money and improving quality of life for patients. The program has increased satisfaction among patients and families, who have greater access to the NPs than they would with physicians. The unit plans to move into a new building, expanding to 28 beds and adding 1 attending.