The Merging of Medical and Surgical Oncology to Provide an Optimal Continuum of Care

Susan Bruce, MSN, RN, OCN, AOCNS1 • Jodi Hollis, MHA, BSN, RN, CCM2 • Jennifer Loftis, MSN, RN, AOCNS1 Raechel Hill, BSN, RN, OCN1 • Heather Sullivan, MSN, RN2 • Anna Choquette, BSN, RN, OCN3 1 Duke Cancer Center Raleigh; 2 Duke Raleigh Hospital; 3 Duke Women’s Cancer Care Raleigh

DISCUSSION BACKGROUND INTERVENTION IMPLICATIONS FOR PRACTICE

• Growing oncology population increased 250% • Transdisciplinary team was brought together, including • Bringing all these services into the new location has over two years the Oncology Clinical Nurse Specialist helped improve the quality, safety and service of • No dedicated oncology unit • Identified learning needs of staff around chemotherapy inpatient oncology • Growing acuity that required a specialized unit* and symptom management • The attitude of the nurses has been positive and • Nurses were used to caring for surgical patients* • CNS developed 8-hour didactic course, entitled nurses were eager to learn • Minimal experience medical oncology patients Oncology Boot Camp • The didactic learning and hands-on infusion • No experience with chemotherapy • Sessions covered: experience provided a meaningful improvement in • Plan was to transition medical oncology with • Essentials of chemotherapy and the nurses’ ability to care for oncology patients. surgical oncology, creating a blended practice • Essentials of caring for the oncology patient • The CNS continues to present weekly education on a model • Nurses were required to pass a chemotherapy test variety of oncology topics • Nurses were provided a 1-day hands-on infusion • All have been well received experience with a preceptor in our infusion center • The blended model of practice could be used in other • CNS was available on the unit to mentor nurses populations administering chemotherapy the first few times

RESULTS LESSONS LEARNED

To date, 88 nurses have completed Oncology Boot Camp • Inpatient chemotherapy has been sporadic • Extended time for new grad nurses to 1 week in A post-survey revealed: infusion • Many new grad nurses were hired • 87% of nurses felt participation in Boot Camp was • Needed experience on unit first with preceptor meaningful • 75% would recommend the course to others. • One year after the blending of the patient population, we had one safety event related to chemotherapy

Outcomes include: • Increased patient satisfaction • Increased nurse satisfaction • Increased physician satisfaction

Continuity of care has been enhanced for these patients: They can have surgery, return to the same unit for chemotherapy, and continue their oncology journey all on the same unit