The World Health Organisation and the International Council of Nurses expect that there will be a shortage of 5.7 million nurses internationally until 2030. [1,2] The United States’ cancer care workforce lacks more than 2,300 medical oncologists until 2025.  After the current COVID-19 pandemic, it is expected that more (specialised) nurses will leave the profession because they miss physical and psychological safety. 
Introducing advanced practice nurses
To meet patients’ demands and to cope with the shortage of health care professionals, many countries see potential in the introduction of advanced practice nurses (APNs) and their services to national health care systems, as presented in Part I of this EUT series.  These specialised nurses with a master degree provide comprehensive care through multi-dimensional interventions, e.g. coordinative activities to manage needs in the interprofessional care team and by counselling to increase patients’ symptom management.  Advanced nursing practice services are intended to achieve an improvement in patient quality care. 
Nonetheless, a range of organisational and personal factors have an impact on APNs’ job satisfaction and thus on their job performance and patient quality of care.  Job satisfaction is understood as a personal feeling that indicates whether an employee is satisfied or dissatisfied with the work, including a number of factors such as psychological, physiological, and environmental/organisational.  Satisfaction-related factors are divided into intrinsic, which usually increases the feeling of satisfaction, and extrinsic factors, which relates to dissatisfaction. Relevant factors vary regarding the country and organisation-specific environment. Especially APNs working in the primary care setting quite often experience a high case load when providing their services. Even though these APNs enjoy a broad scope of practice, which might relate to a higher level of satisfaction, the remoteness in primary care and the missing educational resources can intensify the feeling of being alone and not supported, which can cause dissatisfaction with the job. 
“Supportive interventions for APNs and registered nurses are necessary to help them cope with the demanding work.”
Organisational and personal factors
Organisational factors – which are relevant in every care setting, such as the lack of legal regulation of advanced practice competencies and the lack of supervision in clinical training, are negatively related to APN’s job satisfaction.  Nonetheless, personal factors, such as a higher number of years of professional experience, a low number of overtime hours, and increased confidence in one’s own role are associated with job satisfaction. 
Variety in work between clinical practice, research, scientific and professional training, and consulting activities leads to better role satisfaction and favours retention in the role.  Nevertheless, if the APNs’ extended scope of practice is not fully exercised, this can cause job dissatisfaction.  However, job-satisfaction-related factors that are relevant in the context of patient care (e.g. caring for patients with a uro-oncological condition) was not found in the latest published literature. The author assumed that relevant factors are more associated with organisational and personal factors than with patient characteristics (e.g. diagnosis) or the complexity of care that needs to be provided to patients.
Coping with work stress
Providing care to patients in a complex care situation (e.g. patients with a cancer diagnosis) under time pressure leads to work stress and is known as a barrier in providing good nursing care.  Literature shows that work stress can result in psychological effects such as burnout, depression, anxiety, and post-traumatic disorders, which are associated with an increased absence from work and the intention to leave the nursing role or profession. [15-17] Supportive interventions for APNs and registered nurses working in specialised care (e.g. uro-oncological care) are therefore necessary to empower them with relevant knowledge and to help them cope with the demanding work.  An example of a supportive strategy is the educational resources offered by the European Association of Urology Nurses (EAUN). If time is lotted for nurses (e.g. in Urology) to attend conferences, meetings, and/or webinars, they may gain knowledge (e.g. learn skills to reduce stress in a demanding working environment). Furthermore, compensation of overtime and the opportunity for personal development might give the needed support. 
To build a resilient nurse workforce in uro-oncological care, the EAUN is working hard to provide different kinds of educational resources. A number of these resources are:
• Bimonthly webinars developed by special interest groups (SIG prostate cancer, bladder cancer, continence, endourology);
• E-courses available to members;
• One to two-day ESUN courses;
• The fellowship programme to get an insight into other national nursing care programmes.
Especially in the time of COVID-19, online resources seem to be the most effective way to reach urology nurses internationally. To stay up to date, it is important that national urology nurses organisations and the EAUN collaborate on providing further educational resources about relevant topics. The EAUN is therefore happy to receive further feedback. Please send your ideas or inquiries to email@example.com.
1. ICN. International Council of Nurses Policy Brief: The Global Nursing shortage and Nurse Retention. 2021 [cited 2021 02.04.]; Available from: https://www.icn.ch/sites/default/files/inline-files/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention.pdf.
2. WHO. State of the World`s Nursing Report – 2020. 2020 [cited 2021 02.04.]; Available from: https://www.who.int/publications/i/item/9789240003279.
3. Mathew, A., Global Survey of Clinical Oncology Workforce. Journal of Global Oncology, 2018(4): p. 1-12.
4. Kim, Y.-J., S.-Y. Lee, and J.-H. Cho, A Study on the Job Retention Intention of Nurses Based on Social Support in the COVID-19 Situation. Sustainability, 2020. 12(18): p. 7276.
5. Geese, F., Provision of advanced uro-oncological care. Part I – EAUN committed to supporting urology nurses in expertise development. European Urology Today, 2021(January/February): p. 31.
6. Alotaibi, T. and C.A. Al Anizi, The impact of advanced nurse practitioner (ANP) role on adult patients with cancer: A quantitative systematic review. Applied Nursing Research, 2020. 56: p. 151370.
7. Lu, H., Y. Zhao, and A. While, Job satisfaction among hospital nurses: A literature review. Int J Nurs Stud, 2019. 94: p. 21-31.
8. Hoppock, R., Job Satisfaction. 1935, New York: Harper and Brothers.
9. Fournier, J., et al., Theory of Nurse Practitioner Job Satisfaction. Journal for Nurse Practitioners, 2019. 15(4): p. 290-290.
10. Steinke, M.K., et al., An examination of advanced practice nurses’ job satisfaction internationally. Int Nurs Rev, 2018. 65(2): p. 162-172.
11. Bryant-Lukosius, D., et al., A survey of oncology advanced practice nurses in Ontario: profile and predictors of job satisfaction. Nurs Leadersh (Tor Ont), 2007. 20(2): p. 50-68.
12. Wild, P., V. Parsons, and E. Dietz, Nurse practitioner’s characteristics and job satisfaction. J Am Acad Nurse Pract, 2006. 18(11): p. 544-9.
13. Han, R.M., P. Carter, and J.D. Champion, Relationships among factors affecting advanced practice registered nurses’ job satisfaction and intent to leave: A systematic review. J Am Assoc Nurse Pract, 2018. 30(2): p. 101-113.
14. Vinckx, M.-A., I. Bossuyt, and B. Dierckx de Casterlé, Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study. International Journal of Nursing Studies, 2018. 87: p. 60-68.
15. Finley, B.A. and K.G. Sheppard, Compassion Fatigue: Exploring Early-Career Oncology Nurses’ Experiences Clin J Oncol Nurs, 2017. 21(3): p. E61-e66.
16. Arimon-Pagès, E., et al., Emotional impact and compassion fatigue in oncology nurses: Results of a multicentre study. Eur J Oncol Nurs, 2019. 43: p. 101666.
17. Bouchard, L., Compassion Fatigue in Advanced Practice Registered Nurses: Why Don’t We Know More? Nurs Clin North Am, 2019. 54(4): p. 625-637.
18. Wentzel, D. and P. Brysiewicz, Integrative Review of Facility Interventions to Manage Compassion Fatigue in Oncology Nurses. Oncol Nurs Forum, 2017. 44(3): p. E124-e140.
19. Peter, K.A., et al., Work-related stress among health professionals in Swiss acute care and rehabilitation hospitals-A cross-sectional study. J Clin Nurs, 2020. 29(15-16): p. 3064-3081.
Franziska Geese, PhD cand, MScN, RN, Bern University of Applied Sciences, Dept. of Health Professions, Berne (CH), firstname.lastname@example.org