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Society ONS included 2 024 oncology nurse practitioners ONPs Process The Oncology Nurse Practitioner Competencies reflect the work of a multi organizational national panel In 2005 ONS convened the panel representing six national nursing organizations whose foci include advanced practice regis tered nursing education oncology nursing practice and certification of oncology nurse
2 ONS Oncology Nurse Practitioner Competencies,Oncology Nurse Practitioner Competencies. National Panel Members, Susan M Cohen DSN APRN FAAN Julie A Ponto PhD c RN APRN BC AOCN. National Organization of Nurse Practitioner Faculties Oncology Nursing Certification Corporation. Kelly A Goudreau DSN RN CNS Margaret Quinn Rosenzweig PhD APRN BC. National Association of Clinical Nurse Specialists AOCNP. University of Pittsburgh School of Nursing,M Tish Knobf PhD RN AOCN. Yale University School of Nursing Joan M Stanley PhD RN CRNP FAAN. American Association of Colleges of Nursing,Deborah B McGuire PhD RN FAAN. University of Maryland, Laura Fennimore RN MSN Cynthia Miller Murphy RN MSN CAE. Oncology Nursing Society Oncology Nursing Certification Corporation. Barbara Sigler RN MNEd,Oncology Nursing Society, Copyright 2007 by the Oncology Nursing Society All rights reserved For permission to reprint adapt post online or. otherwise reuse at your institution please email pubpermissions ons org. ONS Oncology Nurse Practitioner Competencies 3,Validation Panel. Pat Wills Alcoser MSN CPNP Pam Malloy MSN RN AACN, Baylor College of Medicine Texas Children s Hospital American Association of Colleges of Nursing. Deborah H Allen RN MSN FNP APRN BC AOCNP Judie Much APNC AOCNP. Duke Comprehensive Cancer Center The Cancer Institute of New Jersey. Karen Brown FNP C ONP Rosemary Neider RN MSN APRN BC AOCN. Roswell Park Cancer Institute University of Wisconsin Hospital and Clinics. Kathleen Calzone RN MSN APNG Mary Baron Nelson MS RN CPNP CPON. International Society of Nurses in Genetics Association of Pediatric Hematology Oncology Nurses. Cathy J F Cole RNC NP MPH CHES Jean Ridgeway APN NP MSN AOCN. Cooper Finkel Women s Health Center University of Chicago Medical Center. Joan O Hanlon Curry RN MS CPNP CPON Cheryl Rodgers MSN CPNP. The Children s Hospital at Montefiore Baylor College of Medicine Texas Children s Hospital. Lynn Czaplewski RN BC CRNI BSN OCN Barbara Barnes Rogers CRNP MN AOCN. Infusion Nurses Society Fox Chase Cancer Center, Marie Flannery RN PhD Victoria Sinibaldi RN MS CS CRNP BC AOCN. James P Wilmot Cancer Center Johns Hopkins University School of Medicine Johns. University of Rochester Medical Center and School of Hopkins Hospital. Janet Wyatt PhD CRNP, Cathy Haut MS CPNP Pediatric Nursing Certification Board. Pediatric Nursing Certification Board,Lisa M Zajac MSN APRN BC OCN. Michele M Hughes RN MSN ACNP ONP C Barbara Ann Karmanos Cancer Institute. Orthopaedic Nurses Certification Board,Robin King MSN CS ACNP. Barbara Ann Karmanos Cancer Institute,Endorsements. The following organizations endorse the Oncology Nurse Practitioner Competencies. American Nurses Credentialing Center Commission on Accreditation. Emergency Nurses Association,Hospice and Palliative Nurses Association. Infusion Nurses Society,4 ONS Oncology Nurse Practitioner Competencies. Table of Contents,Project Overview 5,Introduction 5. Overview 6,References 7,Oncology Nurse Practitioner Competencies 8. I Health Promotion Health Protection Disease Prevention and Treatment 8. II Nurse Practitioner Patient Relationship 12,III Teaching Coaching Function 12. IV Professional Role 12,V Negotiating Healthcare Delivery Systems 13. VI Monitoring and Ensuring the Quality of Healthcare Practice 14. VII Caring for Diverse Populations 14,Appendix A Bibliography 15. ONS Oncology Nurse Practitioner Competencies 5,Project Overview. Introduction, The American Cancer Society ACS estimates that 1 444 920 new cases of cancer will be diagnosed and that 559 650. Americans will die of cancer in 2007 ACS 2007 Although survival rates continue to climb cancer remains the second. most common cause of death in the United States exceeded only by heart disease Those who survive cancer often continue. to receive treatment and require close follow up care and surveillance The National Cancer Institute NCI estimates. that approximately 10 5 million Americans with a history of cancer were alive in 2003 Some were cancer free whereas. others still had evidence of cancer and may have been undergoing treatment ACS A significant number of advanced. practice registered nurses APRNs provide care to patients with a past current or potential diagnosis of cancer and. very distinct competencies are required to provide this care As of May 2007 the membership of the Oncology Nursing. Society ONS included 2 024 oncology nurse practitioners ONPs. The Oncology Nurse Practitioner Competencies reflect the work of a multi organizational national panel In 2005. ONS convened the panel representing six national nursing organizations whose foci include advanced practice regis. tered nursing education oncology nursing practice and certification of oncology nurse practitioners Additional educa. tors and practitioners were included on the national panel ONS facilitated the work of the national panel through three. phases that encompassed development field review by practicing ONPs and external validation of the competencies. The process used for this project models that used for the development of the Nurse Practitioner Primary Care Com. petencies in Specialty Areas Adult Family Gerontological Pediatric and Women s Health National Organization of. Nurse Practitioner Faculties NONPF American Association of Colleges of Nursing 2002 and the Acute Care Nurse. Practitioner Competencies NONPF 2004, The national panel convened for the first time in February 2005 at the ONS National Office in Pittsburgh PA Dur. ing this meeting the group reviewed the existing body of work including standards of practice for oncology APRNs. and existing competencies for nurse practitioners see Appendix A and began drafting the competencies The national. panel agreed that the Oncology Nurse Practitioner Competencies would build upon the core competencies for all nurse. practitioners and the panel agreed to use the same framework as that used for the primary care competencies in specialty. Following the first meeting the group convened several times by conference call to continue the work A second. meeting was held in April 2005 which again was followed by conference calls to complete phase one of the project. development of a set of consensus based competencies for all ONPs by the national panel. In September 2005 phase two of the project the field review was initiated All ONS members who were nurse. practitioners approximately 1 800 were invited electronically to review the document and evaluate the. Specificity of each competency answering the question Is the competency stated specifically and clearly And if not. nurses could provide suggested revisions, Relevance of each competency answering the question Is the competency necessary for entry level ONPs. Comprehensiveness of the document providing any missing knowledge skill or attribute of the entry level. Approximately 350 ONPs requested a copy of the document to review and 127 completed reviews were received. The field review demonstrated general consensus with the majority of the competencies and provided valuable feedback. for refinement particularly in the area of specificity Following the field review a series of conference calls were held. wherein the national panel reviewed the comments from the field reviewers and revised the document The revised docu. ment was prepared for phase three and the validation process was begun in the summer of 2006. The validation panel included 21 individuals identified as having expertise related to ONP practice Individuals were. nominated to complete the validation process by a wide range of specialty nursing organizations certifying bodies and. NCI designated comprehensive cancer centers, The individuals on the validation panel were identified as having experience in one or more of the following areas. related to the nurse practitioner role or scope of practice. 6 ONS Oncology Nurse Practitioner Competencies,Delivery of oncology care. Education of ONPs,Credentialing of ONPs, Accreditation of graduate nursing education programs. The validation panel members were invited to review and evaluate the document using the same tool that the field. reviewers used and answer the same questions related to specificity relevance and comprehensiveness The validation. process demonstrated general agreement with the competencies and provided valuable feedback for additional revisions. and refinement The national panel was again convened during a series of conference calls to review the feedback from. the validation panel and revise the competencies Based on the feedback approximately 20 of the competencies un. derwent revision to enhance their specificity and five competencies were added and seven competencies were deleted. because of redundancy or consensus that they were not required for entry level ONPs Following the final revisions the. document included 103 entry level competencies expected of all ONPs. At the completion of the validation phase and consensus by the national panel on the final competencies ONS dis. tributed the document for endorsement by national nursing organizations that have a stake in oncology care and advanced. practice registered nursing The endorsement process remains fluid so that additional endorsers can be added to the. electronic posting of the competencies The competencies will be available to all endorsing organizations for electronic. posting on Web sites The intent is for widespread dissemination of the competencies to promote global recognition of. the competencies as quality indicators for ONPs entry into practice. This document describes entry level competencies for ONPs who care for adults and late adolescents Graduate. programs that prepare ONPs include broad educational preparation in advanced pathophysiology pharmacology and. advanced physical assessment AACN 1996 as well as the specific coursework and clinical experiences required to. prepare graduates to care for patients with a past current or potential diagnosis of cancer These competencies are. intended to be used in conjunction with and build upon the core competencies identified for all nurse practitioners see. Appendix A Upon graduation from a graduate oncology nurse practitioner program or entry into advanced oncology. nursing practice the ONP should demonstrate the competencies described in this document. The competencies in this document emphasize the unique philosophy of practice for the ONP specialty and the. unique needs of patients with a past current or potential diagnosis of cancer ONPs are educationally prepared to provide. advanced nursing care to meet the specialized physiologic and psychological needs of patients throughout the continuum. of care including cancer prevention and detection cancer diagnosis and treatment rehabilitation survivorship and end. of life care Although individual ONPs may focus their practice on a particular stage in the continuum they are prepared. to provide primary acute and palliative care to patients with cancer including the application of knowledge of genetics. and genomics As ONPs gain experience their practice may include more advanced and additional knowledge skills. and abilities not included in these entry level competencies. ONPs provide care in a variety of primary acute and tertiary settings including comprehensive cancer care centers. urban and rural community hospitals ambulatory and medical mobile clinics private physician nurse practices com. munity health centers home care palliative care settings hospices rehabilitation centers and extended care facilities. ONPs provide care to specific populations in cancer prevention screening diagnosis active treatment palliative care. and rehabilitation in conjunction with the multidisciplinary healthcare team The ONP s role includes the assessment. diagnosis and management of cancer and related disorders The ONP uses evidence based literature and works toward. evidence based practice to effect a positive change in the health of and healthcare delivered to the patient with a past. current or potential diagnosis of cancer, Throughout this document the term patient refers to adult and or late adolescent individuals their families unrelated. significant others and caregivers and or the community. These competencies in addition to the core competencies NONPF 2006 for all nurse practitioner practice reflect. the current knowledge base and scope of practice for entry level ONPs As scientific knowledge expands and the health. care system and practice change the nurse practitioner competencies will evolve These competencies will periodically. be reviewed and updated to reflect scientific advances and evidence based changes in practice. ONS Oncology Nurse Practitioner Competencies 7,References. American Association of Colleges of Nursing 1996 The essentials of master s education for advanced practice nursing Washington DC Author. American Cancer Society 2007 Cancer facts and figures 2007 Atlanta GA Author Retrieved May 18 2007 from http www cancer org. National Organization of Nurse Practitioner Faculties 2004 Acute care nurse practitioner competencies Washington DC Author. National Organization of Nurse Practitioner Faculties 2006 Domains and core competencies of nurse practitioner practice Washington DC Author. National Organization of Nurse Practitioner Faculties American Association of Colleges of Nursing 2002 Nurse practitioner primary care competen. cies in specialty areas Adult family gerontological pediatric and women s health Washington DC National Organization of Nurse Practitioner. 8 ONS Oncology Nurse Practitioner Competencies,Oncology Nurse Practitioner Competencies. I HEALTH PROMOTION HEALTH PROTECTION DISEASE PREVENTION AND TREATMENT. A Assessment of Health Status, These competencies describe the role of the oncology nurse practitioner ONP in assessing all aspects of the. patient s health status including for purposes of health promotion health protection and disease prevention. The ONP uses evidence based clinical practice guidelines when available to guide screening activities identify. health promotion needs and provide anticipatory guidance and counseling addressing environmental lifestyle. and developmental issues, 1 Obtains and documents a comprehensive health history for patients with a past current or potential. diagnosis of cancer, 2 Uses evidence based practice guidelines and assessment tools for evaluating patients with a past current. or potential diagnosis of cancer,3 Performs a relevant cancer risk assessment for. General populations,At risk populations,Newly diagnosed patients with cancer. Cancer survivors, 4 Obtains comprehensive information related to risk diagnosis and past experience with cancer. 5 Performs and documents complete system focused symptom specific physical examinations for pa. 6 Performs a physical assessment of patients with cancer that includes a comprehensive review of systems. and evaluation of manifestations and toxicities related to cancer and its treatment. 7 Assesses actual or potential late effects of cancer and its treatment e g second malignant neoplasms. cardiomyopathy pulmonary dysfunction in cancer survivors. 8 Assesses the impact of physical comorbidities on cancer symptoms and response to treatment. 9 Identifies the relationship between normal physiology and specific system alterations produced by cancer. and cancer treatment, 10 Assesses symptoms commonly seen in patients with cancer e g fatigue pain nausea vomiting. 11 Assesses for common signs and symptoms related to disease progression or recurrence. 12 Assesses patients who are at high risk for signs and symptoms of oncologic emergencies. 13 Performs a comprehensive assessment of nutritional status in patients with a current or past diagnosis of. ONS Oncology Nurse Practitioner Competencies 9, 14 Conducts a pharmacologic assessment including over the counter medications prescription drugs. nutritional supplements and other complementary alternative and integrative therapies to identify and. correct any potential interactions with cancer therapeutics. 15 Assesses the risks of polypharmacy to the patient s health. 16 Performs a comprehensive assessment of functional status and the impact on activities of daily living. including but not limited to the following domains. Psychological, 17 Assesses for the presence of psychological comorbidities e g anxiety depression substance use past. and present coping skills and the psychosocial impact of the cancer experience. 18 Assesses concerns and issues related to sexual function sexual well being and fertility of patients with. a past current or potential diagnosis of cancer including the impact on relationships. 19 Assesses developmental ethnic spiritual racial socioeconomic and gender variations in symptom pre. sentation or illness experience of patients with cancer. 20 Assesses the roles tasks and stressors of individuals families and caregivers and their ability to manage. the illness experience e g resources support services equipment transportation child care anxiety. depression, 21 Assesses patients ability to navigate the complex healthcare system and the barriers to continuity coor. dination and communication among multiple care providers. B Diagnosis of Health Status, The ONP is engaged in the diagnosis of health status This diagnostic process includes critical thinking dif. ferential diagnosis and the integration and interpretation of various forms of data. 1 Orders screening diagnostic and surveillance examinations or tests. 2 Demonstrates knowledge of technical skills needed to perform diagnostic procedures to confirm or rule. out health problems e g bone marrow aspirations spinal taps skin biopsies. 3 Performs an initial interpretation of laboratory studies and diagnostic tests including but not limited to. chest x ray or electrocardiogram, 4 Reviews diagnostic and laboratory study results to confirm or rule out health problems. 5 Demonstrates knowledge of atypical presentations of cancer. 6 Demonstrates understanding of the principles of cancer staging. 7 Collaborates with relevant healthcare team members and gathers additional information for further dif. ferential diagnosis and problem identification,10 ONS Oncology Nurse Practitioner Competencies. 8 Diagnoses common episodic acute and chronic physical problems in patients with a past or current. diagnosis of cancer, 9 Diagnoses acute and chronic conditions that may result in rapid physiologic deterioration or life threaten. ing instability including oncologic emergencies, 10 Identifies the need for screening for common late effects in cancer survivors e g infertility cardiomy. 11 Reformulates diagnoses based on new or additional assessment data. 12 Determines the impact of comorbidities on the prognosis and treatment of patients with cancer. 13 Diagnoses acute and chronic psychological complications e g anxiety depression substance abuse and. their influence on the patient s psychological state. 14 Documents diagnoses and problems to facilitate identification and initiation of the treatment plan and. outcome evaluation, 15 Demonstrates knowledge of diagnostic and procedural coding documentation requirements. C Plan of Care and Implementation of Treatment, The objectives of planning and implementing therapeutic interventions are to return the patient to a stable. state and to optimize the patient s health These competencies describe the ONP s role in managing the patient. minimizing physical and psychological complications and maximizing the patient s health potential. Plan of Care, 1 Collaborates with the multidisciplinary team patient family and caregivers to formulate a comprehensive. plan of care for patients with cancer including appropriate health education health promotion and health. maintenance rehabilitation and palliative care, 2 Plans for the management of common cancer related episodic acute and chronic problems. 3 Plans for the management of cancer and cancer treatment related symptoms e g pain nausea vomiting. neuropathies infection, 4 Integrates evidence based nonpharmacologic treatment modalities into the plan of care. 5 Plans therapeutic interventions to restore or maintain an optimal level of functioning. 6 Establishes a comprehensive plan of care as patients transition from active treatment to cancer survivor. ship or end of life care, 7 Plans for long term evaluation and management of late effects of treatment. 8 Coordinates care with attention to resource availability accessibility quality and cost effectiveness. 9 Coordinates care within a context of functional status cultural considerations spiritual needs family or. caregiver needs and ethical principles,ONS Oncology Nurse Practitioner Competencies 11. 10 Demonstrates awareness of appropriate clinical trials and research studies for which patients may be. eligible and assists in recruiting patients as appropriate. 11 Incorporates patients developmental learning needs and preferences in planning patient and family teach. 12 Documents the plan of care and intended outcomes to ensure that interventions will be implemented as. Implementation, 1 Uses evidence based strategies in the management of patients across the continuum of care i e preven. tion early detection diagnosis treatment rehabilitation survivorship and end of life care. 2 Monitors and manages the effects of cancer and cancer treatment. 3 Provides anticipatory guidance to assist patients and families in coping with the illness and its potential. or expected outcomes, 4 Considers comorbid conditions when implementing cancer treatment. 5 Treats episodic acute and chronic health problems. 6 Initiates appropriate treatments and referrals for patients experiencing an oncologic emergency e g dis. seminated intravascular coagulation superior vena cava syndrome spinal cord compression. 7 Implements interventions to support patients who have a rapidly deteriorating physiologic condition in. cluding the application of basic and advanced life support and other invasive interventions or procedures. to regain physiologic stability, 8 Educates and supports patients in self care strategies. 9 Refers patients to other healthcare providers for further evaluation as appropriate. 10 Refers patients and families to appropriate support services. 11 Facilitates transitions between healthcare settings to provide continuity of care. 12 Uses an ethical framework in all aspects of patient care to assist patients families and other caregivers on. issues related to the care and management of symptoms advance directives and palliative and end of life. 13 Coordinates palliative and end of life care in collaboration with patients families caregivers and other. members of the multidisciplinary healthcare team, 14 Evaluates the effectiveness of interventions and revises the plan of care as appropriate. 15 Determines the impact of cancer treatment and its side effects and long term effects on patient out. 12 ONS Oncology Nurse Practitioner Competencies,II NURSE PRACTITIONER PATIENT RELATIONSHIP. Competencies in this area demonstrate the personal collaborative and therapeutic approach which enhances the. effectiveness of the ONP s patient care These competencies speak to the critical importance of interpersonal trans. actions as they relate to patient outcomes, 1 Establishes caring relationships with patients families and other caregivers to facilitate coping with sensitive. 2 Facilitates patient and family decision making regarding complex treatment symptom management and end. of life care, 3 Assists patients with cancer and their families in preparing for and coping with grief and bereavement. III TEACHING COACHING FUNCTION, These competencies describe the ONP s teaching function which is to impart knowledge and skills for self care to. the patient The coaching function involves the skills of advocacy support and reinforcement. 1 Develops interventions with patients and families that are consistent with patients physiologic and psychologi. cal needs and values, 2 Uses age appropriate learning principles in patient family and caregiver education. 3 Educates patients families caregivers and the community about cancer risk screening and early detection. 4 Uses evidence based information to help patients with cancer and their families to make informed decisions. 5 Provides information to patients and families to facilitate adherence to cancer treatment supportive care and. 6 Educates patients and families about expected and potential adverse effects and costs as appropriate of pre. scribed pharmacologic and nonpharmacologic treatments and interventions. 7 Educates cancer survivors regarding their risk for long term effects of cancer and its treatment e g second. malignant neoplasm skin cancer cardiopulmonary complications. 8 Facilitates patient decision making by explaining treatment alternatives and potential outcomes including the. option of discontinuing active cancer treatment while optimizing supportive care. 9 Educates patients and families on the risks and benefits of alternative integrative and complementary therapies. including possible adverse interactions with standard and investigational cancer therapies. IV PROFESSIONAL ROLE, These competencies describe the varied role of the ONP specifically related to advancing the profession and en. hancing direct care and management The ONP demonstrates a commitment to the implementation preservation. and evolution of the ONP role, 1 Builds collaborative interdisciplinary relationships to provide optimal care to patients with cancer. ONS Oncology Nurse Practitioner Competencies 13, 2 Promotes life long learning and evidence based practice while continually acquiring knowledge and skills. needed to improve patient care, 3 Recognizes the importance of participation in community and professional organizations that influence cancer. care and support the role of the ONP, 4 Contributes to the knowledge base of the healthcare community through community outreach involvement in. professional organizations presentations publications and participation in research. 5 Maintains professional competence and credentials appropriate to the role and specialty. 6 Disseminates knowledge required to care for patients with cancer to other healthcare workers and caregivers. through peer education staff development mentoring and preceptor experiences. 7 Translates research findings and other evidence for other healthcare professionals to improve the care of patients. with cancer, 8 Promotes the role of the ONP and its significance in improving patient outcomes to the healthcare team third. party payers regulators legislators and the public. 9 Participates in clinical and nursing research to promote positive outcomes for patients with cancer and their. caregivers, 10 Advocates within the healthcare system and policy arenas for the health needs of patients with cancer. V NEGOTIATING HEALTHCARE DELIVERY SYSTEMS, These competencies describe the ONP s role in achieving improved health outcomes for patients communities. and systems by overseeing and directing the delivery of clinical services within an integrated system of health. 1 Assists patients with cancer and their families and caregivers to negotiate healthcare delivery systems. 2 Creates and enhances positive health promoting environments that maintain a climate of dignity and privacy. for patients with cancer, 3 Identifies aspects of the healthcare system that create barriers to comprehensive cancer care and long term care. for cancer survivors, 4 Incorporates knowledge of payment and reimbursement systems and financial resources into the plan of care. for patients with cancer, 5 Documents clinical services provided in accordance with reimbursement regulations and guidelines. 6 Adheres to institutional state and federal laws and regulations related to the care of patients with cancer. 7 Refers patients to appropriate local state and national patient support resources. 14 ONS Oncology Nurse Practitioner Competencies, VI MONITORING AND ENSURING THE QUALITY OF HEALTHCARE PRACTICE. These competencies describe the ONP s role in ensuring quality of care through consultation collaboration con. tinuing education certification and evaluation The monitoring function of the role also is addressed relative to the. monitoring of one s own practice as well as by engaging in interdisciplinary peer and systems review. 1 Applies evidence based practice using quality improvement strategies in providing care to patients with can. 2 Promotes an environment for ethical decision making and patient advocacy for patients with cancer. 3 Participates in the design and implementation of evidence based protocols and processes of care to improve. outcomes for patients with cancer e g decreasing medication errors reducing infection rate pain manage. 4 Uses internal resources e g ethics committee risk management legal department and external resources e g. professional organizations government officials community agencies to facilitate the resolution of moral and. ethical issues, 5 Identifies research questions based on recurrent problems related to the care of patients with a potential actual. or previous diagnosis of cancer, 6 Advocates for patient family rights to make decisions regarding durable power of attorney advance directives. and related issues,VII CARING FOR DIVERSE POPULATIONS. These competencies describe the ONP s role in providing competent care to diverse populations with respect to. culture race ethnicity religion spirituality gender or lifestyle. 1 Recognizes the diversity among patients families caregivers and the community that influences patient deci. sions and outcomes of care, 2 Recognizes the impact of provider and institutional cultural biases on cancer care. 3 Recognizes the potential limitations of assessment methods and tools in a diverse population. 4 Incorporates resources that meet the diverse needs of patients into the planning and delivery of care. 5 Educates professional and lay caregivers to provide care with attention to individual diversity for patients with. ONS Oncology Nurse Practitioner Competencies 15,Appendix A Bibliography. American Association of Colleges of Nursing 1996 The essentials of master s education for advanced practice nursing Washington DC Author. American Association of Colleges of Nursing John A Hartford Foundation Institute for Geriatric Nursing 2004 Nurse practitioner and clinical nurse. specialist competencies for older adult care Washington DC Author. American Cancer Society 2007 Cancer facts and figures 2007 Atlanta GA Author Retrieved May 18 2007 from http www cancer org. Jacobs L A Ed 2003a The master s degree with a specialty in advanced practice oncology nursing 4th ed Pittsburgh PA Oncology Nursing. Jacobs L A Ed 2003b Standards of oncology nursing education generalist and advanced practice levels 3rd ed Pittsburgh PA Oncology Nursing. Jacobs L A Ed 2003c Statement on the scope and standards of advanced practice nursing in oncology 3rd ed Pittsburgh PA Oncology Nursing. National Organization of Nurse Practitioner Faculties 2003 Psychiatric mental health nurse practitioner competencies Washington DC Author. National Organization of Nurse Practitioner Faculties 2004 Acute care nurse practitioner competencies Washington DC Author. National Organization of Nurse Practitioner Faculties 2006 Domains and core competencies of nurse practitioner practice Washington DC Author. National Organization of Nurse Practitioner Faculties American Association of Colleges of Nursing 2002 Nurse practitioner primary care competen. cies in specialty areas Adult family gerontological pediatric and women s health Washington DC National Organization of Nurse Practitioner. Oncology Nursing Certification Corporation Chauncey Group International 2003 Role delineation for advanced oncology certified nurse AOCN.