Boosting Nurse Competency with Antineoplastic Onboarding in Oncology

Through a multimodal training framework, investigators at Hackensack University Medical Center successfully prepared more than 100 oncology registered nurses (RNs) for the complexities of modern cancer care, according to findings presented at the 51st Annual Oncology Nursing Society (ONS) Congress.¹

Specifically, researchers evaluated a large-scale chemotherapy onboarding initiative to bolster nursing competency and safety during the administration of antineoplastic agents. The project addressed the need for standardized, specialized education among inpatient RNs caring for patients with cancer and ensured new staff reached clinical proficiency within a set timeframe to mitigate system-level risks and support high-quality patient outcomes.

Main data

The onboarding initiative yielded robust results regarding nurse preparedness and program completion. A total of 100 RNs successfully completed the full chemotherapy training program during the 2024 and 2025 evaluation periods. This cohort demonstrated high levels of clinical engagement, though 5 medical oncology RNs resigned or transferred before finishing the validation process.

Data from post-program surveys indicated significant success in building staff morale and readiness. Investigators reported that 100% of the participating nurses felt "confident" in their ability to safely administer antineoplastic agents to patients with cancer. Furthermore, the initiative demonstrated that a structured approach could efficiently move a large volume of staff through a complex curriculum without compromising quality. Only 1 RN required formal remediation before they were able to successfully complete the final competency validation, suggesting the training materials were highly effective for most of the population.

“Overall, between 2024 and 2025 the average time to competency for those units was 2.8 months from when they completed the eight hour in-person didactic class for hematology oncology and our stem cell transplant and cellular therapy [SCTCT] units,” Melanie Longo, MSN, APN, AGPCNP-BC, TCTCN, CRRN, oncology nurse specialist at Hackensack University Medical Center, stated in the presentation.¹ “We see a lot more volume of chemotherapy in those areas due to conditioning regimens and inductions… the time to compensate was about 3 weeks [for] those events. Overall, this initiative demonstrates that a structured, multimodal chemotherapy training program can successfully and efficiently prepare large cohort nurses for safe chemotherapy administration.”

Trial details 

The initiative utilized a multimodal training program designed to meet Oncology Nursing Society (ONS) standards for safe administration. The foundational component of the curriculum was the ONS/ONCC Chemotherapy Immunotherapy Certificate course, which provided the necessary didactic background.² This was supplemented by a 4-hour training session dedicated to the electronic medical record (EMR) oncology application to ensure accurate documentation and safety checks.

Following the digital and didactic work, RNs attended an 8-hour, instructor-led didactic and skills session. The final phase involved 3 distinct clinical competency validations performed in the clinical setting:

• Validation for 2 unique antineoplastic infusions.
• Validation for 1 intravenous (IV) push administration.

The oncology specialist team provided dedicated support throughout this process to coordinate validations and ensure timely completion of all requirements.

Patient characteristics 

The population evaluated in this initiative consisted of approximately 175 inpatient RNs within the oncology service line at a large academic medical center. Specifically, the project targeted 105 new RNs who were beginning their careers in specialized oncology units. These nurses represented six distinct inpatient units:

• 2 medical oncology units.
• 2 hematology oncology units.
• 2 stem cell transplant and cellular therapy (SCTCT) units.

The goal for this population was to begin formal chemotherapy training once they reached 6 months of clinical experience, with a target for full completion by the conclusion of their first year at the institution.

Main end points 

The primary end point of the initiative was to ensure that all 105 new RNs on the inpatient oncology units reached full chemotherapy training competency within 1 year of hire. Success was measured by the completion of the multimodal curriculum and the successful execution of clinical validations. Secondary end points included the assessment of nurse confidence levels through post-program surveys and the identification of any needs for formal remediation during the training process. Investigators also aimed to demonstrate the scalability of a structured education program within a well-resourced academic institution.

Safety 

Safety was a central tenet of the onboarding initiative, aligned with the ASCO–ONS standards for antineoplastic therapy administration.³ The program ensured safety for both clinicians and patients with cancer by requiring comprehensive competency validation before any unsupervised administration of hazardous drugs. Beyond initial onboarding, the institution established protocols for ongoing proficiency to maintain high safety standards.

Current safety maintenance includes annual competency assessments that focus on both antineoplastic administration and hazardous drug spill management. Additionally, RNs are required to complete a biennial ONS/ONCC certificate renewal to stay current with evolving safety guidelines. The investigators noted that the dedicated support of the oncology specialist team was critical for ensuring that competency was not only achieved but also maintained across the diverse oncology service line. While the single-center design was noted as a limitation for generalizability, the structured framework provided a clear roadmap for mitigating medication error rates and supporting a prepared workforce.

References

1. Longo M. Building a confident and competent workforce: evaluating a large-scale oncology nurse chemotherapy onboarding initiative. Presented at: 51st Annual Oncology Nursing Society (ONS) Congress; May 13-17, 2026; San Antonio, TX. Abstract 42
2. Education of the Nurse Who Administers and Cares for the Individual Receiving Antineoplastic Therapies. Oncology Nursing Society. July 2024. Accessed May 14, 2026. https://tinyurl.com/2kpddyu3
3. Siegel RD, LeFebvre KB, Temin S, et al. Antineoplastic therapy administration safety standards for adult and pediatric oncology: ASCO–ONS standards. Oncology Nursing Forum, 2024;51(3):1-24. doi:10.1188/24.ONF.1-24.AP