Nationwide, some 20,000 nurses have been certified by the Oncology Nursing Society, meaning they have advanced training in cancer care, and in some cases, a master's degree. Though the society is working to relieve the shortage of nurses, by 2015, "the U.S. expects 114,000 full-time registered nurse vacancies," writes Marcia Satryan, RN, MSN. Satryan is the national secretary for the society and an adjunct professor at the University of Pennsylvania in Altoona.

But patients can also play a role to make certain they receive the best nursing care possible, says Satryan. Patients can simply ask any nurses who care for them, first, if he or she is a registered nurse. Secondly, they can inquire as to whether he or she is certified by the society, says Satryan.

"Those are very important questions," she says, adding that if the patient is a child, the nurse should have the training offered for pediatric providers. Satryan also suggests that patients get a sense of whether their nurse "is giving them as much attention as they need." The ratio of nurses-to-patients varies based on the nurse''s duties and where they are working, but if a patient asked, a nurse would probably say whether he or she is over-worked, says Satryan.

"The major problem that I would anticipate [from a shortage] is that patients could receive chemotherapy from individuals who are untrained. You want someone who knows the ins and outs of the medications they are giving," says Satryan.

The Difference Oncology Training Makes

A nurse with oncology expertise "brings an understanding of the disease process and the treatments," adds Mary Callaghan, RN, MSN, a clinical supervisor for GenQuest Biomedical Education Services, Inc., in San Diego. "She can help prepare the family, hook them up with other patients who are similar, and she can identify problems and intervene before they occur. She can decrease side effects and even rehospitalizations. And in my experience it is the oncology nurse who really pushes the physician if the pain control is not adequate. We won't just accept `that's the way it is.'"

Callaghan, who also has advanced certification from the Oncology Nursing Society, says that a close nurse-patient or nurse-family relationship permits patients to ask questions more freely.

"A lot of patients who have an open dialogue with their providers have better care. I always say there are no stupid questions. It is the uninformed person who might run into trouble. I had a woman call me on a Saturday morning to tell me she had problems the night before with her husband. Patients can easily talk about nausea and vomiting but they can't always talk about sexual problems; a lot of [cancer] drugs can cause sexual problems. And that can really affect the family."

The American Cancer Society?s (ACS) Joy Fincannon, RN, MN, agrees. She suggests that patients become as educated as possible about the treatment and side effects they may encounter?and be prepared to quiz their nurses.

"You can ask how much oncology patient experience they have. Not everybody belongs to the nursing society. If you can feel that the person has hands-on knowledge, then you can feel confident," says Fincannon, a clinical nurse specialist in psychiatric-mental health nursing and an oncology certified nurse at ACS.

"What you really want is answers to your questions. Oncology patients can get very ill, very quickly, and the care is very complex. You want someone who knows what normal complications and side effects are, and how to intervene quickly when necessary," she says.