Helping a new oncology nurse gain confidence in the administration of chemotherapy and immunotherapy takes more than just education. Nurses must be able to apply their newly learned knowledge to a direct patient care situation to promote safe care for patients receiving systemic therapy (chemotherapy, immunotherapy, and targeted therapy). Each health care organization “should provide both didactic learning followed by successful completion of a clinical practicum,” according to the Oncology Nursing Society’s (ONS) Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice.
What Is a Chemotherapy Clinical Practicum?
A chemotherapy clinical practicum is a designated time for nurses to apply their didactic knowledge to the care of patients. Since most chemotherapy courses and learning activities do not have a hands-on component or a specific skills lab, nurses must practice these skills in a safe environment with a seasoned oncology nurse before independently administering chemotherapy.
Clinical practicums pair a new chemotherapy nurse with an experienced nurse to provide guidance, supervision, and direct observation. The preceptor and the nurse share an assignment of patients receiving systemic therapy, and the nurse plans and provides care for the patients under the preceptor’s supervision. Typically, there is an administration of chemotherapy competency checklist to ensure consistency in the teaching of administration and standardization of practice. The preceptor evaluates the nurse on required administration skills before concluding the practicum and allowing the nurse to work independently.
How Long Is a Chemotherapy Clinical Practicum?
The clinical practicum length of time varies depending on the nurse’s abilities, skills, and confidence. It continues until the practicum objectives and institutional requirements are met. The volume and types of systemic therapy administration in the nurse’s clinical area are other factors that affect the length of the practicum. Nurses working in high-volume areas, such as an infusion center or hematology unit, will have more opportunity to demonstrate their competence in chemotherapy administration than in a low-volume inpatient unit.
What Are the Key Components of a Clinical Practicum?
Practicums should include time for the nurses to review policies and institutional guidelines related to chemotherapy administration. The nurse should know how to access policies and guidelines quickly and may want to print or save them electronically for easy access. Oncology nurses must understand specific chemotherapy teaching tools and their roles in patient education before drug administration.
ONS’s Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice outlines key components of a clinical practicum such as:
- Selection and proper use of personal protection equipment (PPE)
- Safe handling and disposal of hazardous drugs
- Appropriate physical and laboratory assessments
- Venipuncture and vascular access device selections and maintenance
- Spill management
- Identifying and managing extravasations
- Management of an infusion reaction
- Patient and family education needs
Institutional policies and checklists should outline the minimum number and type of systemic therapy administrations. ONS recommends a minimum of 3 different agents, types, and routes, including non-vesicant and vesicant agents and both IV push and short-term infusion routes.
It may not be realistic for nurses to demonstrate all competency requirements in their clinical setting, so alternatives may include working in another area where chemotherapy is administered, such as an outpatient infusion center or a larger institution, to allow more clinical experiences. Creating a simulated environment for the nurse to demonstrate required skills, such as an IV push vesicant, is also a great option.
What Clinical Practicum Documentation Is Needed?
All practicum elements should be carefully documented in the nurse’s employee file. Competency tools or checklists can ensure coverage of all critical elements, such as:
- Chemotherapy and immunotherapy administration
- Hazardous drug administration safe handling
- Extravasation management
- Hazardous drug spill management
The ONS provides examples of competency tools in its clinical guidelines book. Annual continuing education and ongoing competency assessment are required for nurses to continue administering chemotherapy and should be outlined by the health care organization.
Organizations should support best practices that allow for ample opportunity for new chemotherapy nurses to practice administering chemotherapy and immunotherapy in a safe environment. A strong foundation in administering systemic cancer therapy through education and a clinical practicum ensures a confident and knowledgeable oncology nurse and, of highest importance, provides safe outcomes for patients receiving these drugs.
ONS: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice