Building a Framework for the Future of Cancer Nursing

By Dr Carla Thamm, Project Lead, Australian Cancer Nursing Capability Framework

As I reflected during our recent podcast discussion, it was exciting to finally see the Framework introduced to the profession, to hear the enthusiasm for this framework and how cancer nurses were already beginning to think about using it in their own practice/workplace. The response confirmed something we had sensed throughout the project: people were ready for something new.

That does not diminish what came before it. The National Cancer Nursing Education Project, or EdCaN Framework, was a seminal piece of work. For more than 20 years, it helped shape cancer nursing education and professional development in Australia. It established the important principle that all nurses have a role in delivering safe, person-centered cancer care and provided a foundation that influenced this framework and others nationally and internationally.

Our task was not to replace that legacy. It was to build on it.

Since the EdCaN Framework was launched in 2009, there have been significant advances in genomics, precision medicine, immunotherapy, targeted treatments and surgical and radiation techniques that have transformed the diagnosis and treatment of cancer. Telehealth, virtual care and remote monitoring have become part of routine practice, while a growing number of people are living with and beyond cancer and require ongoing survivorship and supportive care.

Cancer nursing has evolved alongside these changes. Cancer nurses work across the whole cancer continuum. They deliver complex clinical care, coordinate services, educate patients and colleagues, lead nurse-led models, undertake research and contribute to service improvement.

We need a framework that reflects this breadth and is flexible enough to continue evolving as cancer care changes. The need was reinforced by research. Our international scoping review identified 29 cancer nursing frameworks across 34 publications. While many provided valuable guidance, there was significant variation in terminology, structure and scope. Clinical practice was prominent, but education, leadership, management, research and career development were not always represented consistently.

The review confirmed that comprehensive frameworks have an important role in supporting workforce development, professional growth, education, job satisfaction and retention. It also highlighted the need for a contemporary Australian framework that could bring these elements together in a coherent way.

The development of the AusCaN Framework was grounded in what Australian cancer nurses told us about their working lives.

Contemporary evidence highlights that cancer nursing is facing significant workforce pressures, including challenges with recruitment, retention, burnout, role ambiguity, limited advancement opportunities, and inconsistent pathways to specialist and advanced practice roles. Previous national workforce survey findings demonstrated that many Australian cancer nurses were considering leaving the profession within the next decade, with concerns particularly evident among experienced and advanced practice nurses.

Importantly, Australian cancer nurses highlighted the need for clear and transparent career pathways, equitable opportunities for promotion and recognition, access to ongoing education and professional development, opportunities to work to their full scope of practice, career mobility, leadership development, and stronger pathways into research, education, and management roles. The survey also underscored frustration with inconsistent role titles and a lack of clarity regarding progression from novice to specialist and advanced practice positions.

A national framework cannot solve workload, funding or workforce shortages on its own. However, it can provide nurses, employers, educators and policymakers with a shared foundation from which to address them.

Why capability rather than competency?

The decision to develop a capability framework was deliberate.

Competencies remain essential in nursing. They are particularly important when assessing whether someone can safely and consistently undertake a defined clinical task. However, cancer nursing is not simply a collection of tasks.

Capability includes the ability to draw on knowledge, skills and previous experience, adapt them to new situations, continue learning and respond to complexity. This distinction is increasingly important in a field where treatments, technologies, evidence and models of care are continuing to evolve.

The AusCaN Framework describes what cancer nurses need across three levels: Essential, Specialised and Advanced. Each level builds on the one before, but they are not intended as a rigid hierarchy or assign capability solely according to a job title.

A nurse may demonstrate advanced capability in one area while continuing to develop in another. An experienced nurse moving into cancer care may bring strong leadership or clinical capabilities but require cancer-specific knowledge and skills. A specialist cancer nurse may move laterally into education, research, management or another area of clinical practice.

The Framework is designed to accommodate those real career journeys. This approach is also consistent with the International Society of Nurses in Cancer Care’s position that nurses require accessible education across all levels of practice, tailored to local context and individual scope.

It was important that the AusCaN Framework was not developed by a small group in isolation.

The first phase involved an international scoping review, analysis of workforce and education data, and consultation with more than 100 cancer nursing stakeholders, including patient advocates. This work informed an initial set of capability statements across four domains: Clinical Practice, Education, Leadership and Management, and Research and Innovation.

The second phase involved a modified Delphi consensus process. Eighty cancer nurses from every state and territory participated across two rounds of structured surveys. They represented the breadth of the workforce, including clinicians, educators, managers, executives, academics and researchers.

Following the Delphi process and further consultation with the Framework Advisory Group and clinical experts, 149 capability statements were included in the final Framework.

That breadth of participation matters. It means the Framework reflects contemporary practice across different roles, services, locations and career stages.

The Framework is intended to be practical. A nurse could use it to reflect on their strengths, identify areas for development or consider how to progress their career. An educator might use it to map existing programs and identify gaps. A manager or health service might use it to inform position descriptions, workforce planning, professional development or service design.

Importantly, it provides a shared language. It allows us to talk more consistently about what knowledge and skills are required in contemporary cancer nursing, while still giving services the flexibility to apply it within their own context.

This work directly supports CNSA’s strategic commitment to enhance the careers of cancer nurses and improve cancer nursing practice through evidence-based professional development.

Launching the Framework is not the end of the project. The next stage is implementation, supported by practical resources, education, national conversations and the growing connection between AusCaN and CNSA’s cancer nursing education initiatives.

My hope is that, five years from now, our workforce data will tell a different story. I hope we see improved equity in access to education, clearer expectations within nursing roles, stronger career pathways and more nurses being supported to work to their full scope of practice.

Ultimately, the success of the AusCaN Framework will not be measured by how often it is downloaded. It will be measured by whether nurses can see themselves within it, use it to grow and translate that growth into better care for people affected by cancer.

• Cancer Nurses Society of Australia. Australian Cancer Nursing Capability Framework. First edition. 2026. Available at: https://www.cnsa.org.au/implement/auscan.html
• Thamm C, et al. Cancer Nursing Frameworks to Guide Clinical Capability, Education and Careers: A Scoping Review of the International Literature.  J Adv Nurs. 2025 Jul;81(7):3504-3527. doi: 10.1111/jan.16657. Epub 2024 Dec 9. PMID: 39651683.
• McErlean G, Paterson C, Thamm C. Building Career Pathways for Cancer Nurses: Ensuring Cancer Nursing’s Future. Seminars in Oncology Nursing. 2024;40:151633.
• International Society of Nurses in Cancer Care. Cancer Nursing Education Position Statement February 2026. Available at: https://isncc.org/Position-Statement .