Oncology Fellowships Prepare Nurse Practitioners to Take On Multiple Roles

When Ana Adriazola, DNP, RN, AGPCNP-BC, graduated in 2017 from George Mason University in Fairfax, Virginia, with her doctorate, she knew her future was in oncology. So she applied to the Post Graduate Fellowship in Oncology Nursing program offered at The University of Texas MD Anderson Cancer Center in Houston.

“I wanted to immerse myself in the oncology field to ensure I had exposure to all aspects of treatment and care,” says Adriazola, who started working as a hospital secretary on the oncology unit at Virginia Hospital Center in Arlington. After earning her bachelor’s degree in nursing, she worked as a nurse in the same unit.

When the highly competitive MD Anderson program was launched in 2005, it was the first of its kind in the country. Today, similar programs exist, including the Seattle Cancer Care Alliance’s (SCCA) advanced practice provider fellowships in both oncology and bone marrow transplant for recent NP and physician assistant (PA) graduates.

The 1-year program combines classroom learning with hands-on experience. Nurse fellows also prepare to take the Advanced Oncology Certified Nurse Practitioner (AOCNP) exam to earn an AOCNP credential.

“I’ve had the opportunity to see how departments such as palliative care and psychology work as part of a multidisciplinary team in cancer care,” Adriazola says. “I’ve also learned about the policy side of oncology by attending a national oncology conference and authoring an academic manuscript to be published in a peer-reviewed journal.”

Each fellow chooses an area of specialization during the last half of the program. For Adriazola, that meant working in genitourinary (GU) care. At the end of the fellowship, she accepted a job in GU oncology at MD Anderson.

ADVANCED PRACTICE NURSES JOIN PHYSICIAN ASSISTANTS IN UNIQUE FELLOWSHIP

Shahin Carter, MS, PA-C, heard about the SCCA fellowship after graduating last year from the PA program at Heritage University in Toppenish, Washington. The 1-year comprehensive fellowship, held in conjunction with Fred Hutchinson Cancer Research Center and the University of Washington, launched in 2017 and offers 3 recent PA or NP graduates the chance to experience intense clinical subspecialty training.

“I started my fellowship in October and have completed rotations in hematology malignancies, palliative care, the pain clinic, and inpatient care,” Carter says. “I’m currently starting a 3-month rotation in outpatient care and bone marrow transplants.”

Carrie Anne Graham, MSN, ARNP-BC, who serves on the fellowship committee at SCCA, says the paid fellowship program was launched to train the next generation of PAs and NPs to provide highly specialized care in the oncology field. Graham notes that within the next decade, PAs and NPs are expected to play a critical role in meeting the projected demand for oncology services. A study commissioned by the American Society of Clinical Oncology predicts that the demand for oncology visits will increase by 48% by the year 2020, whereas the visit capacity is expected to increase by only 14%.¹ Reasons include an aging population, a growing number of cancer survivors, and expanding treatment options that may require an increase in visit frequency.

“Other fellowship programs tend to be either PA or NP centric, but we wanted to take a teambased approach,” says Tanisha Mojica, ARNP, who also serves on SCCA’s fellowship committee.

FELLOWSHIP OPENS THE DOOR TO COMPLETE ONCOLOGY CARE

Carter learned how to work as part of a multidisciplinary care team to improve patient care. Mojica says the program is designed to help fellows learn leadership skills and gain confidence in their roles so they can hit the ground running and succeed in their jobs. “Our fellowship program removes the pressures of on-the-job learning that many NPs and PAs face when they accept a job directly out of graduate school,” Mojica says.

Also, Mojica adds, NPs who complete a fellowship or a residency program typically have an advantage over other advanced practice nurses when applying for jobs. Because the fellowship speeds up the learning curve, it also prepares them to take on different roles in oncology care and opens up opportunities for advancement and higher salaries.

“We have a nationally recognized clinical trial and transplant program at SCCA, so fellows are learning about cutting-edge treatments,” Graham says. “Our curriculum covers the different malignancy groups and offers didactic time, seminars with mentors, and a better understanding of hematologic malignancies.”

When devising their fellowship program, the SCCA committee worked with other hospitals that offered similar fellowship programs, Graham notes. “We modeled our fellowship in part after the MD Anderson program. We also worked with Seattle Children’s Hospital to learn about their combined APP fellowship program for PAs and NPs interested in pediatrics,” she says.

“We ask our fellows for feedback on the program on a weekly basis and how we might make adjustments to the curriculum and ensure there is a cohesive relationship between fellows and their mentors,” Graham says.

FELLOWSHIPS BENEFIT BOTH NURSES AND HOSPITALS

“Fellowships offer nurses an experience beyond what they learn in most graduate programs,” Mojica says. “They also benefit hospitals by preventing burnout among new nurses, reducing turnover, and improving hospital performance.” Carter admits that if not for the fellowship, she would have gone directly from graduate school to working on an oncology unit.

“The fellowship provides a supportive environment where I can be exposed to all the facets of oncology care,” Carter says. “I’ve had the chance to work as part of a multidisciplinary team and care for patients [with cacner] and their families. It’s definitely made me a better clinician.”

Reference

Vogel WH. Advanced practitioners in oncology: meeting the challenges. J Adv Pract Oncol. 2010;1:13-18. doi: 10.6004/jadpro.2010.1.1.2.