Highlights
- •ONN and APN experience a lonely journey during the integration and execution of their functions
- •There is a constant search for partners, (medical) knowledge and acknowledgement from the interprofessional team and patients
- •This search is driven by 3 contextual factors: role ambiguity, team environment and presence/absence of coaching and guidance
- •Knowledge of expert nursing roles in healthcare professionals and healthcare managers is needed to improve role integration
Abstract
Purpose
Exploring the persisting presence of underlying processes, dynamics, experienced barriers
and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse
Navigators (ONN) during their role integration in an interprofessional team over a
research period of seven years.
Methods
A qualitative study based on the principles of Grounded Theory, in which individual
semi-structured interviews and focus groups were conducted with 51 ONN and APN from
11 university and local hospitals in Belgium between 2011-2018. Data were analyzed
to develop a framework that consists of different themes.
Results
ONN and APN experienced a lonely journey during role integration. They were searching
for partners, medical knowledge and acknowledgement from the interprofessional team.
ONN and APN had a watchful attitude and tried to make themselves visible to ensure
they were involved in the team and to preserve their role and responsibilities. An
unclear role description to the interprofessional team, and a lack of coaching and
guidance were influencing factors in the experience of ONN and APN.
Conclusion
ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional
teams. A lack of role clarity, the interprofessional team environment and a desire
for coaching and guidance are influencing factors to implement APN roles. Coaching
and mentorship of novice ONN/APN and their interprofessional team and healthcare managers
are needed to address these issues. These findings could form the basis for a mentorship
program for ONN/APN and their interprofessional team to enhance role integration.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Oncology NursingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Role transition after clinical nurse specialist education.Clin. Nurse Spec. 2018; 32: 71-80
- Nurse navigator core competencies: an update to reflect the evolution of the role.Clin. J. Oncol. Nurs. 2018; 22: 272-281
- Text analysis: qualitative and quantitative methods.in: Bernard H.R. Handbook of Methods in Cultural Anthropology. Alta Mira Press, Walnut Creek, CA1998: 595-645
- Understanding the role of advanced practice providers in oncology in the United States.J. Oncol. Practice. 2018; 14: e518-e532
- A framework for the introduction and evaluation of advanced practice nursing roles.J. Adv. Nurs. 2004; 48: 530-540
- National cancer plan.([Online]. Available:)http://www.e-cancer.be/kankerplan/Documents/2008%20Rapport%20Kankerplan_NL.pdfDate: 2008Date accessed: July 17, 2022
- Standardizing roles: evaluating oncology nurse navigator clarity, educational preparation, and scope of work within two healthcare systems.Clin. J. Oncol. Nurs. 2019; 23: 52-59
- Advanced practice nursing in radiation oncology.Semin. Oncol. Nurs. 2006; 22: 203-211
- The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners.J. Adv. Nurs. 2017; 73: 3007-3016
- Enablers and challenges to advanced nursing and midwifery practice roles.J. Nurs. Manag. 2019; 27: 271-277
- From unit based to population focused: transforming the role of oncology clinical nurse specialists.Clin. Nurse Spec. 2012; 26: 103-106
- Constructing Grounded Theory.Sage, 2014
- A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework.Eur. J. Cancer Care. 2018; 27e12881
- Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.Implement. Sci. 2009; 4: 50
- Introducing Advanced Practice Nurses/Nurse Practitioners in health care systems: a framework for reflection and analysis.Swiss Med. Wkly. 2008; 138: 621-628
- The development of an oncology clinical nurse specialist fellowship program.J. Adv. Pract Oncol. 2019; 10: 775-787
- The advanced practice nurse in oncology: an opportunity to meet the fast evolving needs in cancer care.Belgian J. Med. Oncol. 2020; 14: 93-99
- Nurse practitioners in the emergency department: barriers and facilitators for role implementation.Adv. Emerg. Nurs. J. 2016; 38: 43-55
- Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review.BMJ Open. 2021; 11e048171
- Advice Concerning the Funtion Profile of Future Nursing Care.2017
- CN3 - introducing the role of the advanced clinical practitioner in haematology and oncology.Ann. Oncol. 2018; 29: viii683
- Applied Thematic Analysis.SAGE Publications, Inc, Thousand Oaks, CA2012https://doi.org/10.4135/9781483384436 (Available at:)Date accessed: December 6, 2022
- Factors influencing the implementation of advanced midwife practitioners in healthcare settings: a qualitative study.Midwifery. 2018; 66: 88-96
- Hamric and Hanson's Advanced practice nursing : an integrative approach.6th edition. Elsevier/Saunders, St. Louis, Missouri2019
- Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis.Ontario Health Technol. Assessment series. 2013; 13: 1-66
- Integrating nurse practitioners into radiation oncology: one institution's experience.J. Adv. Pract Oncol. 2014; 5: 42-46
- Qualitative Research in Nursing and Healthcare.John Wiley & Sons, 2016
- Guidelines on Advanced Practice Nursing 2020.2020 ([Online]. Available:)https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdfDate accessed: July 17, 2022
- Systematic review of oncology nurse practitioner navigation metrics.Clin. J. Oncol. Nurs. 2015; 19: 308-313
- From challenges to advanced practice registered nursing role development: qualitative interview study.Int. J. Nurs. Pract. 2015; 21: 896-903
- Advanced nursing roles: a systematic review.Nurs. Health Sci. 2012; 14: 421-431
- The role of the specialist nurse.Heart. 2002; 88: ii33-ii35
- Efficacy of the competency-based oncology patient navigator training.J Oncol Navig Surviv. 2018; 9: 519-524
- Evaluation of the role of the clinical Nurse Specialist in cancer care: an integrative literature review.Eur. J. Cancer Care. 2021; 30e13415
- Practice patterns and perceived impact of clinical nurse specialist roles in Canada: results of a national survey.Int. J. Nurs. Stud. 2013; 50: 1524-1536
- The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review.J. Eval. Clin. Pract. 2014; 20: 1106-1123
- Boundary work and the introduction of acute care nurse practitioners in healthcare teams.J. Adv. Nurs. 2012; 68: 1504-1515
- The advanced practitioner and collaborative practice in oncology.J. Adv. Practitioner Oncol. 2015; 6: 515
- Novice oncology nurse navigator: core elements in establishing training needs and building on competencies.Clin. J. Oncol. Nurs. 2019; 23: 387-394
- Exploring role clarity in interorganizational spread and scale-up initiatives: the ‘INSPIRED’ COPD collaborative.BMC Health Serv. Res. 2018; 18: 680
- Providing novice navigators with a GPS for role development: oncology nurse navigator competency project.Clin. J. Oncol. Nurs. 2016; 20: 33-38
- Oncology Nurse Navigators Core Competencies.2013 ([Online]. Available:)https://www.ons.org/sites/default/files/ONNCompetencies_rev.pdfDate accessed: July 17, 2022
- Oncology Nurse Navigator Core Competencies.2017 ([Online]. Available:)https://www.ons.org/sites/default/files/2017ONNcompetencies.pdfDate accessed: July 17, 2022
- Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework.Implement. Sci. 2017; 12: 21
- The roles and challenges of oncology navigators: a national survey.J. Oncol. Navigat. Survivorship. 2017; 8: 14-22
- Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review.J. Adv. Nurs. 2011; 67: 1178-1190
- International Council of Nurses: Advanced Nursing Practice.John Wiley & Sons, 2009
- A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance.BMJ. 2021; 374: n2061
- Barriers to delivering advanced cancer nursing: a workload analysis of specialist nurse practice linked to the English National Lung Cancer Audit.Eur. J. Oncol. Nurs. 2018; 36: 103-111
- Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Int. J. Qual. Health Care. 2007; 19: 349-357
- A legal framework on advanced practice nursing in Belgium: what do we and don't we know?.Acta Clin. Belg. 2020; : 1-6
- The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: a qualitative study.Eur. J. Oncol. Nurs. 2019; 43101674
- Global Strategy on Human Resources for Health: Workforce 2030.2016
- Scientific advances shaping the future roles of oncology nurses.Semin. Oncol. Nurs. 2016; 32: 87-98
- Outcome measurement: patient satisfaction scores and contact with oncology nurse navigators.Clin. J. Oncol. Nurs. 2019; 23: 76-81
Article info
Publication history
Published online: December 20, 2022
Accepted:
December 14,
2022
Received in revised form:
December 6,
2022
Received:
September 4,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
