Caring for patients with cancer encompasses more than simply treating a diagnosis. Nurses working in outpatient oncology must address the complex psychosocial needs faced by their patient population. Preparing a new graduate nurse to thrive in this environment requires thinking far beyond technical skills. They must be equipped with the tools to deliver holistic patient-centered care.

Due to the misconception that a nurse’s initial role is best suited for the inpatient setting, new graduates are frequently overlooked when ambulatory care staffing needs are considered. However, as the complexity of care delivered in specialty clinics such as oncology expands, so too does the need for new graduates to begin their professional careers in that environment.

At a large academic medical center, an existing nurse residency program added an ambulatory care track to support this growing care delivery area. In August 2021, the first cohort of two ambulatory care nurse residents matched to the institution’s outpatient cancer center. While charting the course for a new graduate is never easy, navigation tools provided by professional nursing organizations and clinical knowledge obtained from expert oncology nurses served as a roadmap for transition to practice.

Utilizing resources from the American Academy of Ambulatory Care Nursing, clinical nurse educators developed a series of lectures exploring foundational concepts that new ambulatory care nurses must master. These key aspects included ambulatory care nursing as a specialty, patient teaching, care coordination, telephone triage, and patient-centered care. Simulation experiences, quizzes, and games were integrated to promote retention. Interactive discussions on psychosocial aspects of ambulatory care nursing encouraged residents to reflect on their concerns about transition shock and explore personal strategies for successful transition to practice.

To provide a framework for the resident’s clinical experiences, clinical nurse educators and departmental leaders developed a learning pathway and rotation schedule. Paired with seasoned oncology nurse preceptors, residents rotated through multiple medical oncology subspecialty clinics. For a more comprehensive understanding of diagnostic and treatment options, they rotated through the radiation oncology, infusion, and magnetic resonance imaging areas. Finally, the residents shadowed on the inpatient oncology floor to better understand transitions of care.

Due to the multidimensional concepts inherent in cancer care, a PhD-prepared nurse practicing in outpatient oncology delivered a series of lectures analyzing these unique challenges. Presentation topics from this lecture series included scientific basis of cancer, clinical trials, oncologic emergencies, and psychosocial factors of oncology care.

With the success of the inaugural cohort, the ambulatory care nurse residency track's next available start date will expand from one launch clinic to four or more participating clinical specialties. Based on the amount of currently accepted job positions, the number of residents in the second cohort is projected to double.

While traditional onboarding experiences are important to all new graduate nurses, understanding holistic care holds special importance for developing the outpatient oncology nurse. Addressing the intricate psychosocial needs of this patient population throughout the ambulatory care nurse resident’s onboarding better prepared them to reach independence in provision of care to the patient with cancer.

Mari Ann Lewis BSN, RN-BC

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