The ONS position statement, Education of the Nurse who Administers and Cares for the Individual Receiving Chemotherapy, Targeted Therapy, and Immunotherapy, states that there should be specialized education, preparation, and training of the nurse who administers and monitors systemic cancer therapies, which helps to ensure a safe level of care for individuals receiving and the clinicians administering these agents (ONS, 2017). Any individual administering these agents should receive this specific training regardless of the indication, route of administration, or patient population. This is for the safety of not only the patient receiving these drugs but also the individuals who are preparing, handling, transporting, administering, and disposing of these drugs, and for anyone in the environment in which these drugs are handling or administered.

Each institution needs to determine its own policies and procedures regarding what nurses need to complete and how long they need to be in practice prior to chemotherapy administration and associated responsibilities. However, ONS's position is that the nurse has completed didactic training as well as a chemotherapy competency validation to be deemed chemotherapy competent and able to be involved in administration and verification. ONS recommends including the following in all introductory and annual competency reassessment programs developed for nurses administering cancer therapies:

• Types, classifications, and routes of administration 
• Pharmacology of agents, regardless of indications for use 
• Pertinent molecular biomarkers 
• Chemotherapy and radiotherapy protectants 
• Principles of safe preparation, storage, labeling, transportation, and disposal of agents 
• Administration procedures
• Appropriate use and disposal of personal protective equipment 
• Assessment, monitoring, and management of patients receiving therapy in the care setting 
• Patient and family education for these agents, specific to side effects and related symptom management, and processes for urgent and ongoing follow-up 
• Assessment of, education on, and management of post-treatment care, including follow-up care procedures, late or long-term side effects, and physical and psychosocial aspects of survivorship

Ongoing competency assessment is always a challenge, especially when any drug or procedure is given or performed infrequently. ONS recommends that competency is reinforced annually but does not dictate how to assess competency. Some institutions may choose to identify those high-risk, low-volume events or tasks and assess competency on these alone; others choose to fully reassess a complete checklist. 

The Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice state that competency assessment is ongoing, may be done by peers or supervisory staff, and can be measured in several ways (see chapter 1) (Olsen, LeFebvre, & Brassil, 2019). Appendices A and B provide templates of competency validation forms that can be considered for use at your practice. 

ONS does offer two different preparatory courses, depending on the depth and breadth of hazardous drug administration and care of specialized patients. This schema outlines the differences. ONS encourages all nurses who would be giving these drugs and/or caring for this patient population to receive adequate training; these courses are endorsed as such didactic training.

The ASCO/ONS Chemotherapy Administration Safety Standards, available at https://onf.ons.org/onf/44/1/2016-updated-american-society-clinical-oncologyoncology-nursing-society-chemotherapy  also may support the development of competencies that are specific to a population, the drugs administered, etc. 

References:

Olsen, M., LeFebvre, K., & Brassil, K. (Eds). (2019). Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice. Oncology Nursing Society: Pittsburgh, PA.

Oncology Nursing Society (2017). Education of the nurse who administers and cares for the individual receiving chemotherapy, targeted therapy, and immunotherapy. Online Position Statement.