1. Standards and Competencies for Cancer Chemotherapy Nursing Practice in Canada: CANO/ACIO AN INTRODUCTION

2. Objectives To introduce the CANO/ACIO Standards and Competencies for Cancer Chemotherapy Nursing Practice and supportive tools and documents To review the Standards and Competencies development process To begin discussion on how the Standards and Competencies can be integrated into practice

3. Background The Canadian Association of Nurses in Oncology (CANO/ACIO) is the national organization that supports Canadian Nurses to promote and develop excellence in oncology nursing practice, education, research and leadership. The National Strategy for Chemotherapy Administration (NSCA/SNAC) is a special initiative of CANO/ACIO that seeks to establish national chemotherapy administration standards, competencies and educational resources for oncology nurses across Canada.

4. Why do we need a National Strategy for Chemotherapy Administration? Increasing number and complexity of chemotherapeutic regimens (including oral) No national standards for Registered Nurses (RNs) administering and caring for cancer patients receiving chemotherapy Inconsistent chemotherapy nursing care across the country Potential risk to patients, families, and nurses Chemotherapy educational resources for RNs are often inaccessible and rarely include whole person care

5. A National Strategy for Chemotherapy Administration (NSCA) VISION : Every patient across Canada, regardless of geography, receives chemotherapy treatment and care from oncology nurses who meet a predetermined standard of practice through a comprehensive education program designed to ensure ongoing competency. StandardsCompetencies Educational Resources

6. Standards and Competencies for Cancer Chemotherapy Nursing Practice Provides standards for RNs: – Practice – Education – Continuing competence CANO/ACIO’s Position Statement on Cancer Chemotherapy Administration and Care underpins standards

7. CANO/ACIO Position Statement on Cancer Chemotherapy Administration and Care Cancer chemotherapy is high risk and complex Cancer chemotherapy administration and care should be provided by Registered Nurses (RNs) RNs require specific knowledge and skills to provide cancer chemotherapy administration and care Cancer chemotherapy administration and care requires a quality practice environment

8. A National Strategy for Chemotherapy Administration A Key Knowledge Exchange Strategy NATIONAL CHEMOTHERAPY STRATEGY Standards Competencies Education Resources Phase 1 Sept-Dec 2008 Laying the Foundation Lit review Environmental Scan Detailed Action Plan Phase 2 Jan 2009-July 2011 Development Standards Competencies Phase 3 Sept 2011+ Implementation, Evaluation, Sustainability Education Resources/ Strategies

9. What do the Standards & Competencies mean for you and your practice…? Leads to “standardized”, optimal cancer chemotherapy nursing practice in Canada Applies to Registered Nurses (RNs) who provide cancer chemotherapy care throughout Canada Provides general direction to RNs Establishes criteria for education programs Provides a foundation for recommendations for quality practice environments

10. How were the Standards and Competencies (S&C) developed? Phase 1 Membership survey (2007) identified need Think Tank articulated vision and action plan Environmental scan including survey and focus groups Literature search Phase 2 Consensus building process used to develop S &C Experts, members and stakeholders provided feedback Phase 3 Implementation of the S &C nationally Evaluation of standards Education tool development Strategy to ensure sustainability

11. Standards and Competencies for Cancer Chemotherapy Nursing Practice Standard A: Accountability for Practice – Includes RN competencies Standard B: Quality Practice Environments Standard C: Competency Development Educational Requirements Standard D: Continuing Competency Program

12. Standard A: Accountability for Cancer Chemotherapy Nursing Practice and Care in Canada by Registered Nurses RNs shall provide safe and competent cancer chemotherapy nursing care by demonstrating the following competencies:

13. Competency 1: Comprehensive Health Assessment RNs shall perform and document comprehensive health assessments at the onset of cancer chemotherapy treatments and continuing throughout the cancer care continuum

14. Competency 2: Supportive and Therapeutic Relationships RNs providing care chemotherapy care will establish, monitor, and maintain supportive and therapeutic relationships while providing cancer chemotherapy care to persons living with cancer.

15. Competency 3: Management of Cancer Symptoms and Treatment Side Effects RNs providing cancer chemotherapy care will manage cancer symptoms and treatment side effects in collaboration with the inter-disciplinary health care team.

16. Competency 4: Teaching and Coaching RNs providing cancer chemotherapy care will provide teaching and coaching specific to the assessed learning needs of persons receiving cancer chemotherapy.

17. Competency 5: Facilitating Continuity of Care\Navigating the System RNs providing cancer chemotherapy care work to promote continuity of care and help persons navigate the health care system.

18. Competency 6: Decision-Making and Advocacy RNs providing cancer chemotherapy care promote autonomous decision-making and advocate for the well-being of persons receiving cancer chemotherapy care.

19. Competency 7: Professional Practice and Leadership RNs providing cancer chemotherapy care participate in and support professional practice and leadership.

20. Standard B: Quality Practice Environment for Optimal Cancer Chemotherapy Nursing Practice 1. Organizational Systems: RNs shall advocate and promote adequate systems to ensure a quality practice environment for the care of persons receiving cancer chemotherapy within their organizations.

21. Standard B: Quality Practice Environment for Optimal Cancer Chemotherapy Nursing Practice 2. Organizational Policies and Procedures: RNs shall advocate and promote appropriate policies, procedures and processes related to cancer chemotherapy care within their organization.

22. Standard B: Quality Practice Environment for Optimal Cancer Chemotherapy Nursing Practice 3. Continuity of Care: RNs shall advocate and promote collaboration and communication between settings and providers responsible for the care of persons receiving cancer chemotherapy to develop processes, policies and procedures ensuring continuity and safe transfers of care.

23. Standard C: Educational Requirements for Developing Competence in Cancer Chemotherapy 1.RNs shall complete the requirements for a chemotherapy educational program prior to accepting responsibility for persons requiring cancer chemotherapy care. 2.The cancer chemotherapy education program shall include a theoretical and clinical evaluation component, including supervised clinical practice.

24. Standard C: Educational Requirements for Developing Competence in Cancer Chemotherapy 3. The education program shall include, at a minimum, the topics indicated in the S&C document. 4. Organizations shall determine and provide education on additional competencies required to provide care within their system, and evaluate the outcomes.

25. Standard C: Educational Requirements for Developing Competence in Cancer Chemotherapy 5. An objective evaluation of learning shall be conducted after completion of the theoretical education. 6. The clinical practice component follows the completion of the theoretical component and shall include supervised clinical experience with an RN who has specialized knowledge, skill, critical thinking, and clinical judgment in cancer chemotherapy care.

26. Standard D: Cancer Chemotherapy Continuing Competence Program RNs shall demonstrate continuing competence in cancer chemotherapy annually Continuing competence programs include: – Identification of learning needs – The development of individualized learning plans – A strategy to report achievement of continuing competence

27. Standards and Competencies Toolkit A toolkit was developed to provide resources to support the dissemination of the Standards and Competencies nationwide. Tool #1: Promotional Poster Tool #2: National Resource List – coming soon Tool #3: Recommended Content for Organizations to Include in Cancer Chemotherapy Policies Tool #4: Self Assessment Tool and Learning Plan Tool #5: Introductory PowerPoint presentation

28. The Standards and Competencies for Cancer Chemotherapy Practice and Toolkit Can be found on the CANO\ACIO website: http://www.cano- acio.ca/national_chemothera py_administration_standards http://www.cano- acio.ca/national_chemothera py_administration_standards

29. Your Thoughts? What will the S&C look like in your practice? What is already in place at your organization to support the S&C in practice? What is missing? What are the challenges to S&C implementation in your organization? What will enable implementation? What are the consequences of not implementing these S&C for Chemotherapy Nursing Practice? ( for patients? For RNs? For the organization?)

30. We want to hear from you. Please forward your comments, questions, and suggestions to CANO/ACIO at cano@malachite-mgmt.comcano@malachite-mgmt.com