Norton Cancer Institute leaders Stephanie Allison, MSN, APRN, FNP-C, left; Vivien Rosenberger, APRN, FNP-C; and Monica Key, DNP, BSBM, APRN, ANP-C, AOCNP, collaborate on the enhanced orientation program.

Nurses make up the single largest segment of our nation’s health care workforce. Within this rewarding and challenging profession, advanced practice providers often focus on specialties such as cardiology, neurology and oncology.

Oncology, in particular, presents distinct challenges. Providers who enter this specialty do so with no previous cancer education, experience or skills. Professional organizations and literature describe this “practice gap” as a national clinical issue.

Norton Healthcare is striving to close this gap.

Monica Key, DNP, BSBM, is a hematology-oncology nurse practitioner at Norton Cancer Institute. She is part of a quality improvement process team working on an enhanced onboarding program geared to assist new and generalist advanced practice providers who enter the complex field of oncology.

“This is truly a systemwide initiative with incredibly talented representation and leadership from so many people,” Monica said.

Work on the project began in March 2018 with a survey of all advanced practice providers to identify their needs. Data collected produced a top 10 list of learning topics crucial within the first three months of entering oncology practice. These same 10 topics ranked on the survey as “very important” beyond initial orientation.

The three orientation topics cited as most important were:

  1. Recognizing and managing oncology emergencies
  2. Ordering and interpreting lab tests (such as pathology)
  3. Ordering and interpreting imaging tests

Monica wrote an article that provides more details about the survey and strategies for implementing the new onboarding process. It was published by the Association of Community Cancer Centers in early 2019.

The work so far is phase one of an ongoing continuous improvement process. A special committee is looking at next steps to strengthen onboarding and orientation for the more than 300 advanced practice providers across multiple specialties throughout the Norton Healthcare system.

“Research shows that nursing fellowships and residency programs bolster recruiting, improve morale and reduce turnover,” Monica said.

Effective onboarding and training help keep valued providers in the Norton Healthcare family, which strengthens our capacity to provide patients with quality care.