Promoting APP professionalism in hematopoietic stem cell transplantation
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The number of APPs continues to increase considerably in the U.S., with higher health care costs and physician shortages — particularly in rural areas lacking health care access — driving this increase.
In fact, more than 270,000 nurse practitioners (NPs) and 115,000 physician assistants (PAs) are certified health care providers across the country.
We also have seen an increase in APPs practicing in subspecialty areas, including hematology/oncology and hematopoietic stem cell transplantation. Stem cell transplant APPs contribute to the team and patient care in a variety of ways, such as by completing pretransplant evaluation and education, ordering chemotherapy, performing procedures, communicating with referring teams, providing graft-versus-host disease management, and in the general care of an extremely complex patient population.
Research shows APPs require continued opportunities for broadening their professional development to ensure the delivery of high-quality cancer care. As the APP role continues to expand in the field of HSCT, clinical practice may be strengthened through mentorship, active engagement in professional organizations and continuing education.
Formal, informal mentorship
Clinical mentorship — which may take place in a formal or informal manner — is fundamental in the professional development of novice providers.
Larger transplant programs may have an advanced orientation program for newly hired APPs, for whom a clinical practice mentor is assigned. When both the mentor and mentee are committed, this arrangement can be extremely beneficial for a novice provider who is acclimating to the advanced responsibilities and expectations of the new role.
Even without an official program in place, experienced APPs are encouraged to informally mentor new HSCT APPs. Providing clinical advice, resources and ongoing education to new APPs early in their career will aid in the development of clinical expertise.
Once the APP has become more experienced, it is essential that the mentor-mentee relationship also evolve. For example, transitioning from a novice to an experienced APP requires a greater level of program involvement. The mentee may need assistance identifying evidence-based practice or quality improvement initiatives within the organization to become more involved.
Formal mentoring programs within professional organizations provide additional opportunities for experienced practitioners to contribute to the specialty field while fostering professional growth of novice transplant APPs at other institutions. In this format, specific goals are created. Then, scheduled conference calls between the mentor and mentee provide ongoing guidance, resources and support. Being from a completely different institution is a resource within itself, as the mentor may offer insight for new protocols, procedures and quality improvement initiatives.
Mentorship by physician colleagues should not be forgotten. A transplant physician who invests the time and energy into promoting APP professional involvement can be extremely impactful in career advancement. APPs should consider actively seeking physician collaboration within their transplant teams for clinical presentations, publications and research involvement.
Active engagement in professional organizations
Active membership in professional organizations is an expectation of health care providers. Although few stem cell transplant organizations exist, most hematology/oncology organizations include a transplant clinical specialty area group.
Professional involvement offers a multitude of opportunities including advocacy, networking, grant funding, continuing education, clinical practice guidelines and publication.
It is the professional obligation of APPs to contribute to our field through publications and research presentations. Sharing research, scholarly work and knowledge is important to promote evidence-based practice patient care. Even publications on uncommon case reports contribute to science and health care.
Experienced transplant APPs may serve on a variety of committees and boards and in other leadership areas within our professional organizations. New APPs who are interested in becoming more involved may need assistance in this pursuit. They have not yet established professional connections and networking, as this sometimes takes years to develop. However, experienced APPs can offer recommendations to special interest groups, working groups and other committees of interest.
Education
In addition to mentorship, a variety of formal and informal educational opportunities are available for stem cell transplant providers.
Experienced APPs have clinical expertise regarding transplant-specific considerations, such as conditioning regimen, antimicrobial therapy and GVHD. Daily inpatient rounds offer a practical method for APPs to provide education to health care team members, including medical students, nurses and other APPs. This is especially important given that most academic programs offer limited exposure to the care of patients undergoing HSCT.
The transplant providers at our institution, including physicians and APPs, have started a monthly educational series for inpatient nurses. The nurses choose a transplant-related topic about which they would like to learn more. Each transplant provider alternates in providing the monthly educational lecture. This offers a dedicated time for nurses to learn more about transplant topics, such as conditioning regimen, disease processes and supportive care, and GVHD. APPs are given the opportunity to provide this education and often continuing education hours are offered to the nurses.
APPs must also stay up-to-date regarding new information that may impact HSCT patient care. The Foundation for the Accreditation of Cellular Therapy requires at least 10 hours of APP continuing education related to cellular therapy each year. Educational conference attendance, webinars, online learning modules and grand rounds are a few methods through which this may be achieved.
As demand for APPs continues to increase, so will enrollment in academic programs. Many formal educational opportunities exist for APPs. Precepting students in the clinical area or part-time faculty positions may be appealing, and many academic programs will even offer adjunct faculty positions with limited benefits for clinical preceptors.
APP positions have increased in both the primary and subspecialty care areas partly due to rising costs, physician shortages and lack of health care access. APPs are an essential part of the stem cell transplant team, positively impacting patient care. It is the responsibility of all APPs to promote the professional role of our specialty practice.
References:
American Association of Nurse Practitioners. NP fact sheet. Available at: www.aanp.org/about/all-about-nps/np-fact-sheet. Accessed Jan. 16, 2020.
American Society of Clinical Oncology. J Oncol Pract. 2017;doi:10.1200/JOP.2016.020743.
Foundation for the Accreditation of Cellular Therapy. International standards for hematopoietic cellular therapy production collection, processing, and administration, version 7.0. 2018. Available at: www.ebmt.org/sites/default/files/2018-06/FACT-JACIE%207th%20Edition%20Standards.pdf. Accessed Jan. 16, 2020.
McCorkle R, et al. Clin J Oncol Nurs. 2012;doi:10.1188/12.CJON.382-387.
National Commission on Certification of Physician Assistants. 2018 statistical profile of certified physician assistants by specialty annual report. Available at: www.nccpa.net/research. Accessed Jan. 16, 2020.
For more information:
Misty D. Evans, DNP, APRN, CPNP-AC, BMTCN®, is nursing instructor in the pediatric acute care nurse practitioner program at Vanderbilt University and nurse practitioner with Sarah Cannon Research Institute at TriStar Children’s Hospital. She can be reached at misty.evans@vanderbilt.edu.
Disclosure: Evans reports no relevant financial disclosures.
HemOnc Today collaborated with Association of Pediatric Hematology/Oncology Nurses on the submission of this column. To contribute to this column, contact Alexandra Todak at stodak@healio.com.
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