Oncology Nurse Practitioners in Florida Cannot Sign Chemotherapy Orders
According to the American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) chemotherapy administration safety standards, informed consent for chemotherapy must be documented by a physician prior to chemotherapy administration, and a licensed independent practitioner must be on site and immediately available during all chemotherapy administration. 1
Regulatory Framework for Chemotherapy Orders
The ASCO/ONS safety standards clearly outline the requirements for chemotherapy ordering and administration:
Physician Documentation Requirement: The standards explicitly state that "informed consent for chemotherapy must be documented by a physician in the practice prior to chemotherapy administration." 1
Licensed Independent Practitioner Requirement: During chemotherapy administration, "a licensed independent practitioner is on site and immediately available." 1
Order Verification Process: Before preparation of chemotherapy, a second person (a practitioner or other approved personnel) must independently verify each order, including patient identifiers, drug names, dosages, routes, and calculations. 1
Advanced Practice Provider Roles in Oncology
While nurse practitioners cannot sign original chemotherapy orders in Florida, they can have significant roles in chemotherapy management:
Limited Oncology Practice Provider (LOPP) Designation: Some institutions have developed privileging processes that allow advanced practice providers (including NPs) to modify existing chemotherapy orders and order supportive care medications, but not initiate original chemotherapy orders. 2
Supportive Care Management: Oncology NPs excel at managing chemotherapy side effects, with 66% of patients reporting they best understood adverse effects when explained by nursing staff. 3
Patient Education: ONPs play a crucial role in patient education regarding administration schedules, exception procedures, and disposal of unused medications. 4
Important Considerations and Pitfalls
Avoid Scope Confusion: Do not confuse the ability to modify existing orders or provide supportive care with the authority to initiate chemotherapy orders.
Institutional Policies May Vary: While the ASCO/ONS standards provide the framework, individual institutions may have additional requirements or restrictions.
Documentation Requirements: All chemotherapy orders must include complete documentation with patient identifiers, diagnosis, regimen details, dosage calculations, and supportive care treatments. 1
Team-Based Approach: While physicians must sign chemotherapy orders, the oncology care team functions most effectively when each member works within their defined scope of practice.
Competency Development for Oncology Nurse Practitioners
The Oncology Nursing Society has developed specific competencies for ONPs that define their scope of practice across the cancer care continuum. These competencies provide evidence-based benchmarks to standardize the ONP role while ensuring patients receive high-quality cancer care. 5
ONPs should focus on developing expertise in:
- Patient education regarding chemotherapy
- Management of treatment-related toxicities
- Supportive care
- Coordination of care across settings
By understanding these regulatory boundaries and focusing on their areas of expertise, oncology nurse practitioners can provide valuable contributions to the oncology care team while maintaining compliance with professional standards.