Scope of Practice of Oncology Nurse Practitioner

Advanced Practice Columnist / Guide · Aug 21, 2012

I have some questions regarding what a Nurse Practitioner, who has gone through a program focusing on Oncology (I know Columbia University has a subspecialty program for this as well as some other universities), does.

I am aware of sub-specialty programs for NP's offered in some schools, Oncology, being one of such programs. I am unfortunately not familiar with them but nevertheless, I would like to answer your questions because you should be aware that as APN's move towards implementation of the Consensus Model, the core NP specialties are the only ones that will be recognized for certification across the board in all of the states.

The core NP specialties are: Family NP, Adult/Gero Primary Care NP, Adult/Gero Acute Care NP, Women's Health NP, Family Psych and Mental Health NP, and Neonatal NP. All NP programs that prepare for sub-specialty training in Oncology, Cardiology, etc. like the one you cited must adhere to competencies established in any one of the core NP specialties. I would suggest checking with the program director to figure out which core NP specialty this program will prepare you for.

Do they essentially perform all of the tasks that an Oncologist would? If not, what types of things do they do from a day-to-day basis? Can they decide the plan of treatment for their patients or is that up to the Oncologist they work with?

NP Scope of Practice is dependent upon individual State Nurse Practice Act, and in some states, involvement by the State Board of Medicine. Be aware that scope of practice in most states use very broad terms for NP's such as "assessing", "diagnosing", "prescribing"...so these roles per the Scope of Practice, apply to all NP's regardless of specialty. Physician involvement in NP scope vary and there are states where NP's can be totally independent of physician collaboration/supervision.

In theory, a nurse practitioner working in Oncology can do whatever it is the Oncologist does in those independent practice states. In reality, what the nurse practitioner can actually do would likely depend on their employment arrangement. For instance, NP's who provide care in hospitals are required to seek privileges and credentialing based on what's written on the hospital by-laws. These by-laws have traditionally been physician-authored and can protect physician turf by making sure NP's work under a physician-led practice.

There is absolutely nothing wrong with that arrangement in my opinion because there could still be a high degree of autonomy for the NP under those circumstances even in a practice that involves Oncology patients. Cancer patients are referred to Oncologists by their primary care providers to establish a diagnosis and a plan of treatment. There is a high degree of complexity both in the patient presentation, diagnosis, and care in this patient population and I personally would be comfortable (both as a provider and as a patient) in a setting where NP's and physicians work collaboratively.

For your information, I am attaching maps below that show the extent of independent practice as it stands in all the 50 states:

Source: NCSBN

Advanced Practice Columnist / Guide · Aug 21, 2012

PS: I forgot to include Pediatric Acute Care NP and Pediatric Primary Care NP in the core NP specialties.

chillax63 · Aug 21, 2012

Thank you very much for your detailed response! So from my understanding, it really all depends on where and who work with regarding what you can do (diagnosing, referring, prescribing medication, making care plans etc..).

Advanced Practice Columnist / Guide · Aug 22, 2012

Correct.