What Is Oncology Nursing? The Ultimate Guide to ONC
According to the National Institutes of Health (NIH), cancer was the second leading cause of death in the United States in both 2020 and 2021. According to the American Cancer Society, in 2021 alone, there were approximately 1.9 million new cancer diagnoses. Furthermore, the number of cancer survivors is expected to reach 26.1 million by 2040. In addition to patients with active cancer diagnoses, cancer survivors also require qualified healthcare providers, including oncology nurses. Based on these figures, it is no surprise that the demand for oncology nurses is continuously increasing.
Are you interested in pursuing a career in oncology? Not only are oncology nurses in ever-growing demand, guaranteeing job stability and high salaries for nurses, but this particular nursing specialty offers nurses the opportunity to have an incredibly rewarding career contributing to the improvement of outcomes as well as patients’ quality of life. Whether you are a nursing student, a newly graduated nurse, or an experienced nurse ready for a career change, read on to learn everything there is to know about working as an oncology nurse.
What Does Oncology Mean in Medical Terms?
Based on the definition of the National Cancer Institute, oncology is a branch of medicine specializing in cancer diagnosis and treatment. This treatment encompasses medical oncology, including chemotherapy, hormone therapy, and other drugs; radiation oncology, which refers to the use of radiation to treat cancer; and surgical oncology, which refers to the use of surgery and other procedures to treat cancer.
What Does ONC Stand For?
The abbreviation ONC may stand for oncology or oncologist. Just as oncology is the branch of medicine devoted to treating cancer, an oncologist is a physician who has specialized in diagnosing and treating cancer. Furthermore, an oncology nurse or ONC nurse helps people with cancer or at risk for cancer improve their quality of life and achieve the best possible outcomes.
What Is the Oncology Unit in a Hospital?
Oncology units provide patients with cancer specialized nursing care. Oncology nurses in these units care for patients who have recently been diagnosed with cancer, patients with an active cancer diagnosis, and patients with a history of cancer. These units are usually step-down units or have a step-down component, meaning that they offer an intermediate level of care between what is offered in intensive care units and general wards. Oncology units may also have special rooms for patients receiving end-of-life treatments. These rooms may also have adjacent rooms for family members to be closer to patients nearing the end of their lives.
Patients with cancer are cared for by a multidisciplinary healthcare team, including doctors, nurse practitioners (NPs), registered nurses (RNs), physical and occupational therapists, administrative support staff, nutritionists, social workers, and case managers.
A unique aspect of oncology units is the high level of care and control that must be maintained to avoid infection. This special care must be taken since patients who receive chemotherapy may become neutropenic, meaning that they develop low immunity due to a significant decrease in white blood cells. Therefore, staff and visitors must maintain strict hygiene, and neutropenic patients cannot receive fresh flowers, uncooked fruit or vegetables, or unpasteurized products because of the high level of bacteria that these items or foods may contain.
What Is the Role of an Oncology Nurse?
The role of oncology nurses is to encourage healthy lifestyles for their patients, promote early cancer detection, improve cancer symptoms, and reduce the side effects of cancer treatments to reduce the risks, incidence, and burden of this disease. Oncology nurses also advocate for their patients, coordinate care, provide cancer treatments, support patients and their caregivers, and collaborate with the rest of the healthcare team to reduce the impact of cancer and improve outcomes.
To provide the best possible care, oncology nurses continuously collect and assess patient data; then, they use this evidence to make clinical decisions in collaboration with the rest of the healthcare team and establish goals. Furthermore, ONC nurses stay up-to-date on research findings in cancer and participate in clinical trials with cancer patients.
Nurse Duties: What Does an Oncology Nurse Do?
As with all nursing specialties, oncology nurses perform duties that are common to all nurses but also have responsibilities that are unique to their specialization.
Here are some general nursing duties that oncology nurses also perform:
- Assessing patient data based on interviews, observation, and physical examinations
- Collaborating with multidisciplinary teams
- Executing nursing interventions
- Evaluating patients’ responses to treatments
- Educating patients and family members regarding patient care
- Documenting all assessments and interventions
In addition, here are some responsibilities that are more common for or even unique to oncology nurses:
- Performing telephone triage
- Administering, monitoring, and documenting cancer therapies, such as chemotherapy, administration of blood components, and replacement of fluids and electrolytes
- Assisting providers with procedures
- Assessing, accessing, and maintaining venous access devices
- Performing phlebotomy procedures, such as starting IVs and drawing blood
- Acting as a resource for other nursing staff and participating in educational initiatives
- Coordinating and scheduling patients’ medical procedures and therapy
- Providing support for families, including referrals and bereavement counseling
- Participating in research
How to Become an Oncology Nurse
Oncology nurses are registered nurses with either associate’s or bachelor’s degrees in nursing—although many employers prefer hiring RNs with bachelor’s degrees.
In addition, employers may require a minimum of one or two years of nursing experience, and many prefer hiring nurses with oncology certifications.
Oncology Nurse Certification
As with most nursing specialties, oncology nurses must have Basic Life Support (BLS) certifications, which can be obtained from the American Heart Association.
Furthermore, employers prefer hiring nurses with oncology certifications in addition to nursing experience. The Oncology Nursing Certification Corporation (ONCC) offers various certification options for oncology nurses:
- Oncology Certified Nurse (OCN®)
- Certified Pediatric Hematology Oncology Nurse (CPHON®)
- Certified Breast Care Nurse (CBCN®)
- Blood & Marrow Transplant Certified Nurse (BMTCN®)
To be eligible for these certifications, nurses must hold current, active, and unencumbered RN licenses. They must have at least two years of experience working as RNs within the previous four years. Additionally, they must accrue at least 2,000 hours of clinical practice relevant to their desired certifications. Finally, they must complete at least ten contact hours of nursing continuing education in oncology or an academic elective in oncology nursing within the previous three years.
The ONCC also offers a certification option for nurse practitioners: the Advanced Oncology Certified Nurse Practitioner (AOCNP®). To be eligible for this certification, NPs must hold current, active, and unencumbered RN licenses and complete graduate degrees in either oncology or a program with a concentration in adult (primary or acute), family (across the lifespan), gerontology, or women’s health.
- Applicants with degrees in oncology must complete 500 hours of supervised clinical practice as an adult oncology nurse practitioner over the previous five years and one graduate-level oncology course or thirty hours of oncology continuing education in the last five years.
- Applicants who have completed other nurse practitioner programs must complete 1,000 hours of clinical practice as adult oncology nurse practitioners within the previous five years. They also must complete one graduate-level oncology course or thirty hours of oncology continuing education in the last five years.
In addition, the ONCC offers certifications that are currently only available for renewal:
- Advanced Oncology Certified Clinical Nurse Specialist (AOCNS®)
- Certified Pediatric Oncology Nurse (CPON®)
- Advanced Oncology Certified Nurse (AOCN®)
Visit the ONCC website for more information on certification and renewal.
How Long Does It Take to Become an Oncology Nurse?
Since nurses may work in oncology with associate’s degrees in nursing, becoming an oncology nurse may take as little as two years. However, obtaining a bachelor’s degree in nursing—the preferred level of qualification for many employers—takes approximately four years. In addition, many employers require one or two years of nursing experience. Considering all these factors, becoming an oncology nurse without certifications takes three to six years.
Oncology Nurse Salary
Although the average RN salary is $82,750 per year, according to the US Bureau of Labor Statistics (BLS), one of the main factors affecting oncology nurse salary is the setting where they work. According to Rieger and Yarbro (2003), most oncology nurses work in the following settings:
- Hospital/multihospital system: 43%
- Outpatient/ambulatory care: 24%
- Physicians’ offices: 11%
- Hospice or home care: 3%
Based on BLS data, here are the average salaries of RNs in different work settings:
- Outpatient care centers: $93,070
- General medical and surgical hospitals: $85,020
- Specialty hospitals except for psychiatric and substance abuse hospitals: $84,800
- Home health care services: $78,190
- Offices of physicians: $73,860
Similarly, the average salary of a nurse practitioner is $118,040 per year. However, this average can vary significantly depending on where nurses work. The following are average salaries for nurse practitioners in different healthcare settings:
- Home health care services: $133,170
- Outpatient care centers: $129,190
- General medical and surgical hospitals: $122,960
- Offices of physicians: $114,870
What Is Oncology Nursing Like?
As with many other nursing specialties, oncology nurses have an important educational role. They are experts in cancer and cancer treatments; therefore, they often need to can explain the disease to patients and family members, helping them understand the treatment process and common symptoms and side effects.
Oncology nurses also act as counselors by caring for patients’ emotional well-being. They listen to patients, ask questions, and connect patients and family members to useful resources outside the hospital setting.
Furthermore, a unique aspect of oncology nursing is that besides acting as teachers and counselors for patients, ONC nurses become patients’ friends. This friendship develops naturally as nurses care for and accompany patients over time, celebrating birthdays, holidays, and milestones together—as well as grieving setbacks and losses.
“When you work on an oncology floor you get your patients for a much longer stay or you recognize patients frequently because they are in often. It is easier to build a connection this way and that's something I enjoy so much about oncology.” Reddit – u/aelyons
Is Oncology Nursing Hard?
It probably comes as no surprise that oncology nursing can be emotionally draining for nurses. But you probably wouldn’t have guessed that many nurses find family members the most challenging.
“The con of this type of floor is how emotionally draining some days, weeks, or months are. You HAVE to make sure you are emotionally taking care of yourself.” Reddit – u/aelyons
“What I find far more gruelinggruelling and frustrating is when we have a patient who is clearly dying and the family cannot accept it or come to a consensus and we subject a helpless person who cannot speak for themselves to unnecessary and painful procedures when we know that we're just buying time that can often be measured in a scant number of days.” Reddit – u/andishana
Why Choose Oncology Nursing
Despite challenges, many nurses who work in oncology claim they wouldn’t change their jobs for any other. Based on nurses’ testimonials, caring for patients who actually appreciate their care makes everything worthwhile for nurses.
“The best: having your patient smile even just a little, making their pain better or nausea better, helping them die peacefully with family.” Reddit – u/nightnur5e
“I’ve worked in oncology exclusively for 5.5 years now. And I love it. I hate hearing “ooooo that’s so sad” when I tell people my specialty. Yes it is sad, but it’s not all at once. These patients are a special group of people. They actually want your help. They take your advice. And listen to what you have to say. They call you when they are sick. They rely on you for EVERYTHING. And that’s ok. We are there to guide and to listen. Im 31 and I talk to people daily about death, dying, prognosis, and time left. And those are precious conversations these patients have chosen to confide in me. They teach me every day that life is short...” Reddit – u/Leolover812
What Makes a Good Oncology Nurse: Tips for New Nurses
Through RN licensure, certification, and work experience, oncology nurses develop specialized knowledge, abilities, and skills. The following describes the profile of an excellent oncology nurse:
- Extensive knowledge of oncology treatments, reactions and side effects of treatment, and oncology equipment
- Ability to uphold safety and infection control standards
- Ability to perform patient triage and appropriate referral skills
- Ability to support other members of the healthcare team
- Ability to educate patients and family members regarding care and treatment
- Ability to protect patients’ privacy and maintain the confidentiality of medical records
- Ability to cope with stress and maintain emotional stability
- Knowledge of and ability to apply bereavement counseling techniques
- Effective communication skills
- Ability to work independently
Final Thoughts on Working as an Oncology Nurse
As you read this ultimate guide on oncology nursing, were you able to picture yourself in the role? Do you feel that pursuing this specialty is the right career move for you? If you have decided that oncology nursing is not a good fit, continue to explore other nursing specialties until you find the one that seems custom-made for you!
Furthermore, if you are still unsure what type of nursing work is right for you even after reading all the guides the Internet has to offer, consider picking up per diem shifts in different settings and roles. Nothing beats hands-on experience when it comes to choosing a career path.