Innovative Program Reduces Nurse Turnover and Fosters Development

The Network is acutely aware of the high attrition rates for new oncology nurses during their first years of practice.

Cancer incidence is on the rise in the US, especially among the growing older population.

New cancer cases in 2024 are expected to exceed 2 million, which is almost 5500 cases per day.¹ Consequently, the retention of experienced oncology nurses is crucial to ensure that high-quality cancer care remains available.

Unfortunately, the current shortage of oncology nurses is expected to worsen, as fewer people enter the profession while aging nurses retire. By 2025, a shortage of 200,000 to 450,000 oncology nurses is predicted in the US.² Oncology nursing is a demanding and stressful specialty that is plagued by high turnover, especially for new nurses who often leave in their first year due to multiple stressors they are unprepared to handle. The loss of these nurses creates staffing, economic, and safety concerns, often impacting quality of care.³

In response, The US Oncology Network (The Network) has developed one of the most comprehensive programs in the nation to support the professional development and retention of new oncology nurses.

A closer look at this innovative initiative may be helpful to oncology practices dealing with retention issues as well as practices in other specialties facing similar concerns.

New Oncology Nurses Face Multiple Challenges

The complexity of cancer care is a major hurdle for nurses who are new to oncology, as the learning curve is quite large. Cancer care impacts every part of the human body and creates social and emotional issues that must be managed to achieve optimal outcomes. Nurses entering the field may have had a few lectures about cancer, but they are most likely unprepared to provide many aspects of care required by patients and their families.

Oncology nursing is also challenging because it is constantly evolving, as hundreds of new medications come to market each year. Staying current is difficult for seasoned nurses, let alone new ones who are still learning the job. Compassion fatigue and burnout are also common.

Although great advances have occurred in cancer care, there are many difficult days that take a toll on nurses who support patients and their families during the ups and downs of cancer treatment.⁴ It is a difficult environment, even for experienced professionals.

Initiative Supports Development and Retention of Oncology Nurses

The Network is acutely aware of the high attrition rates for new oncology nurses during their first years of practice.

Approximately one-quarter of the nurses hired into practices in The Network have no oncology background, and they face tremendous challenges trying to learn the complexities of cancer care while on the job.

The Network recognized the importance of providing a supportive and empowering learning environment for new nurses and, in 2022, developed a program to support onboarding activities. The result was the creation of the Oncology Core Education and Networking (OCEAN) program, a comprehensive initiative to support the professional development and retention of new oncology nurses. Designed to enhance their knowledge of fundamental oncology, OCEAN is a collaborative effort bringing together a multidisciplinary team of experts and speakers from across The Network. The program provides fundamental oncology knowledge around 12 core areas delivered over 22.5 hours of live virtual learning. It focuses on high-impact areas every oncology nurse needs to know, whether they work in triage, infusion, research, radiation, or navigation. Content ranges from the core concepts of cancer to various treatment modalities, symptom and pain management, emergencies, and nutrition—all the way to palliative care and advanced care planning.

OCEAN’s impact extends beyond skill development, fostering a sense of belonging and purpose among participating nurses. By emphasizing collaboration and teamwork, the program creates an environment where nurses feel part of something greater than their individual role. Designed to be engaging and interactive, every topic is presented by subject matter experts, and the platform allows for discussion and Q&A sessions. Some presentations are lecture based, whereas others include games and quizzes. A virtual escape room fosters teamwork as participants and their peers apply their knowledge to gain their freedom. The goal is to make learning as enjoyable and effective as possible.

The program launched in April 2023 after 2 pilot programs. A special position was created to manage the program after The Network saw the success of the first pilot. Today, there are more than 170 participants from 26 practices, so the program has garnered substantial support and engagement across The Network.

Initial Results Are Encouraging

Early results from the program are promising, such as increased retention rates and cost savings. Statistics indicate that 82% of past participants are still employed at 1 year compared with the national average of approximately 70%.⁵ This retention rate—12% better than the national average— delivered an estimated cost savings of approximately $1.1 million, which is equivalent to retaining 20 nurses.

Additionally, participants’ knowledge of cancer care and confidence in handling oncology situations dramatically improved. Participants who completed OCEAN between April 2023 and April 2024 experienced a 70% knowledge improvement, as reported on their pre- and postcourse self-assessments. Additionally, 97% rated their onboarding experience as good or excellent.

Impressive Outcomes at Virginia Cancer Specialists

One practice that played a key role in developing the OCEAN program is Virginia Cancer Specialists (VCS), the largest private cancer practice in northern Virginia, with 10 locations. Serving thousands of patients, VCS has a large number of oncology nurses who play a critical role in delivering high-quality care.

During the COVID-19 pandemic and beyond, the practice experienced high turnover of its oncology nursing staff. Some left during the pandemic, and many seasoned nurses retired. High turnover was also occurring among new nurses. The Executive Committee of the Clinical Advisory Council of The Network saw the challenges at VCS and other oncology practices, and took action to tackle the problem by presenting the idea of a centralized onboarding program to The Network.

VCS played an integral role in piloting and launching the initiative, and today it considers the program a resounding success, resulting in less turnover and more engaged employees. In 2021, VCS’ attrition rate was problematic, at 17%. A dramatic improvement occurred after the OCEAN program, and the rate dropped to less than 2% in July 2024. A nurses’ engagement survey also showed remarkable improvement. In 2021, only 49% felt engaged and connected, but this percentage increased to an impressive 91% by July 2024. Nurses feel valued by VCS for helping them gain the knowledge and training they need to succeed.

The program has also enhanced the relationship between new nurses and more experienced ones, shifting from conflict to collaboration. Experienced nurses often challenge new ones, as they are protective of patients and do not want anyone providing care who they don’t think is qualified. Now the nurses have discussions about why things are done a certain way. New nurses explain what they learned in the program, and the more experienced ones talk about how they were trained. Tensions no longer exist, and the experienced nurses are now supportive of their new colleagues, giving them room to grow and learn.

However, there were challenges along the way. Nurses wanted dedicated time off the floor during their classes. Al-locating protected time is difficult when practices are short-staffed, so nursing managers initially resisted. However, VCS felt it was important to hear the concerns of participants who wanted to concentrate on what they were learning and gave them the option to either take their training on-site in a closed office or be paid to take the training at home.

Because it is critical for participants to have protected time, practices must coach their managers so they understand the importance of the program, which is the path to producing a properly educated, well-trained nurse. Today,
VCS has 100% buy-in from its nursing leaders to ensure dedicated time is allocated.

Supporting New Nurses Yields Dividends in Many Areas

The OCEAN program has been a great success, providing much-needed education, training, and support to new oncology nurses who are often overwhelmed by the complexities of cancer care. The program has significantly decreased turnover while fostering more knowledgeable, engaged nurses. It demonstrates the value of The Network, as an interdisciplinary team collaborated to develop this centralized training platform that practices can voluntarily utilize if they lack onboarding resources. Improvements are constantly being made to make the program the best it can be so new oncology nurses feel they are supported, respected, and vital members of the care team.

To ensure success, practices must allocate dedicated time so participants can maximize this vital learning opportunity. By investing in the professional growth and education of new oncology nurses, practices can not only equip them with the necessary skills to provide superior care but also foster a long-term commitment to their careers, practice, and community.

References

1. Collins S. 2024—first year the US expects more than 2M new cases of cancer. American Cancer Society. January 17, 2024. Accessed July 13, 2024. https://www. cancer.org/research/acs-research-news/facts-and- figures-2024.html#

2. Lyon D. Oncology nursing for the future: multisector planning is needed. Oncol Nurs Forum. 2024;51(3):196- 197. doi:10.1188/24.ONF.196-197
3. Mohammed Naholi R, Nosek CL, Somayaji D. Stress among new oncology nurses. Clin J Oncol Nurs. 2015;19(1):115-117. doi:10.1188/15.CJON.115-117

4. Kelly D, Cable M, Jolley C, Nevidjon B. Oncology nurs- ing under pressure. J Adv Nurs. 2024;80(7):2611-2613. doi:10.1111/jan.16116
5. 2023 NSI National Health Care Retention & RN Staffing Report. Workplace Change Collaborative. Accessed July 15, 2024. https://www.wpchange.org/ resources/2023-nsi-national-health-care-retention-rn- staffing-report