Practicing ‘Top of License’ Can Enhance Patient Care, Collaboration

Engaging with patients and providers “at top of license” can open new doors for oncology advanced practice provider (APPs) to interact with both patients and providers in a fulfilling way, according to Una Hopkins, DNP, MSN, FNP-BC, NE-BC, RN, FACCC.

As 2025-2026’s new president of the Association of Cancer Care Centers, her work is inclusive to the roles that nurse practitioners and physician assistants play in oncology. In an interview with Oncology Nursing News®, Hopkins shared that she wants to encourage oncology APPs to incorporate their highest level of education in practice.

She gave examples of ways she has seen this practice in action providing a higher level of care to patients while collaborating with other medical professionals. Hopkins said that as an APP, she was part of an initiative where APPs and fellow providers working in pharmacy would go with patients’ boxes of medications to find potential hazards including conflicting and expired medications.

Hopkins also added that incorporating APPs in peer-to-peer reviews could be an opportunity for APPs to work more with professionals in different areas of specialty and alleviate some of the burden of physicians.

Transcript

I think your APP, your advanced practice [provider], is vital to the care of every [patient with cancer], and when practicing at top of license, they can do so much.

I experienced that myself as a frontline clinician in the APP role. I did several things. Not only did I see patients on a regular basis—prescribe their chemotherapy, watch them right through to survivorship—but there were other things that the APP did, and it facilitated the care of the patient.

For instance, collaborating again with my pharmacy colleagues, an APP initiated a medication clinic in which our patient population would bring their shoebox of medications in—and literally, it was a shoebox—and we would find expired medications, medications that would interact with their current regimen if they had taken them, and so many things that could go wrong. In a 15- to 20-minute visit, we’ve done a really good job at keeping that patient healthy, right?

So that’s what I mean by practicing top of license, and nurse practitioners and physician assistants can be utilized in the care team to facilitate the journey that the patient has in so many ways.

It’s not just about prescribing and it’s not just about assessing. It really is helping them along their entire way, and they can be interacting with the social workers. They can hopefully, someday, in some states, complete peer-to-peer reviews and take that burden from our physician colleagues, who can spend hours on the phone with peer-to-peer reviews.

And sometimes you’re not even talking to an oncologist, you’re talking to a cardiologist or a pediatrician, and you’re not even talking to the right person. So even the language that we use in oncology isn’t getting through to the other person on the other end of the phone. So hopefully APPs will be utilized in some of those ways, because we do have the language and the knowledge set to advocate for our patients in that way.

This transcript has been edited for clarity and conciseness.