The overall turnover rate for oncology nurses is approximately 27%, which jumps to up to a staggering 40% among early-career nurses in their first or second year, according to a podcast by the Oncology Nursing Society (ONS).
What can be done to support oncology nurses and increase retention, especially those starting out? In the same ONS podcast episode, professional development, mentorship from skilled nurses, and opportunities to explore other aspects of oncology nursing, such as ambulatory care rather than inpatient care, were all discussed as valuable ways to keep nurses early in their careers engaged.
We also suggest looking at the safety measures in place and whether nurses feel protected by their employer. Nurses and other healthcare workers face many occupational safety concerns, from verbal and physical violence to exposure to hazardous drugs.
While improvements in PPE and safety equipment, as well as clear safety protocols surrounding their use, help reduce exposure to hazardous drugs, they cannot entirely eliminate the potential dangers. In fact, the CDC’s report titled “The Factors That Influence Chemotherapy Exposure Among Nurses: An Integrative Review” claims that “despite the presence of chemotherapy handling guidelines, nurses report incidents of chemotherapy exposure.”
How can we more fully remove those dangers from employees who are trying to conceive or are breastfeeding?
One answer: alternative duty policies.
Alternative duty policies allow staff who handle or are exposed to hazardous drugs in their daily duties to request reassignment during vulnerable reproductive times. While alternative duty policies are not legally mandated, they are strongly recommended by many authorities.
The CDC and NIOSH recommend that healthcare facilities implement an alternative duty policy, and in a bulletin, they illustrated alternative duty policies from agencies and organizations worldwide. Alternative duty policies are also recommended by the ONS and Hematology/Oncology Pharmacy Association (HOPA), which state, “Institutional policy should describe the process for requesting an accommodation and options available to staff members as they pertain to alternative duty.”
We strongly agree that a comprehensive hazardous drug safety program should include a policy allowing for alternative duty for healthcare employees who are exposed in any way to hazardous drugs and may be in a sensitive reproductive time. Not only does it go further to protect healthcare workers - especially those who are early in their career - but the safety net it provides could improve retention rates.
Where did alternative duty policies originate?
As part of the courageous and impactful work MiKaela Olsen, DNP, APRN-CNS, AOCNS, FAAN, Clinical Program Director- Oncology at Johns Hopkins Hospital and Johns Hopkins Health System, has done around hazardous drug exposure, she has helped educate people on alternative duty policies.
According to an article in Johns Hopkins Nursing, Dr. Olsen was working as an oncology nurse in 1999 when she suffered an ectopic pregnancy. Though it was hard to pinpoint the cause of the lost pregnancy on her daily exposure to chemotherapy drugs, it motivated her to find ways to better protect her colleagues and others exposed to hazardous drugs in their jobs.
These resources are the gold standard for healthcare systems working towards USP <800> compliance and, more importantly, towards fully protecting all healthcare workers from the harmful effects of hazardous drug exposure. We’ve had the privilege to host Dr. AnnMarie Walton, the co-editor of "Safe Handling of Hazardous Drugs," on a webinar episode focused on involving nurses in your hazardous drug safety program planning and implementation. The episode is one of a six-part series, which is free to watch. Blog recaps of each webinar are also available.
While an alternative duty policy is not the answer to all causes of high turnover rates among oncology nurses, it is a safety measure that protects these valuable healthcare workers and can increase morale and employer loyalty, demonstrating that an employer not only values their nurses’ well-being but is committed to keeping them in the profession for the long term.
As always, if you have any questions or comments regarding alternative duty or any other topic related to hazardous drugs, formulary, patient safety, or healthcare worker safety, we’re here to help. Email us at info@rpharmy.com.