Administering chemotherapy requires extensive knowledge and skill as well as practical experience (Wickham et al. [267]). To provide consistently safe, appropriate and high‐quality patient care, the nurse must be assessed as being competent to administer chemotherapy. The National Chemotherapy Advisory Group (NCAG) has recognized the need for chemotherapy to be administered and managed by knowledgeable chemotherapy‐trained nurses to ensure quality and safety (NCAG [163]). Individual hospitals and organizations provide educational input along with practical experience in administration of chemotherapy. The NCAG has highlighted the need for high‐quality, continual professional development to maximize and provide safe and effective care. It also recommends that the National Peer Review Team audits cancer services and that subsequently areas such as nurse chemotherapy competencies should be self‐assessed on a yearly basis (NCAG [163]).

National standards for safe administration of chemotherapy have been developed by the American Society of Clinical Oncology and the Oncology Nursing Society (ONS) in America, the aim of which was to improve patient safety (Neuss et al. [172]). The Royal College of Nursing has produced standards for infusion therapy and states that the nurse managing chemotherapy should have knowledge of and technical expertise in both administration and specific interventions associated with cytotoxic agents and have received education and training (RCN [201]). Standardizing education and practical guidelines for safe administration of chemotherapy reduces the risk of error. Having a comprehensive knowledge and skill base for administering chemotherapy also ensures that the nurse is fit for purpose (NMC [177]).

Competency documents, such as the UKONS Systemic Anti‐cancer Therapy (SACT) Competency Passport (UKONS [248]), have been developed to ensure that the nurse has the required knowledge and skill to safely administer chemotherapy. Following a period of training, theoretical and practical competency needs to be demonstrated by the practitioner and recorded by the assessor. The competency is reaccredited annually. Competency frameworks and assessment tools are adopted within most organizations.

Non‐medical prescribing of chemotherapy has been developed over the years, with many organizations having nurse‐led chemotherapy prescription clinics as part of normal practice. The Cancer Reform Strategy (DH [46]) advocated nurse‐led chemotherapy services for cancer patients to improve the patient experience and reduce waiting times. Improving efficiency of services for patients was echoed in the National Chemotherapy Advisory Board (DH [49]) report which identified the need to improve the patient care experience by ensuring quality and safety. Nurse‐led interventions, such as nurse‐chemotherapy prescribing and assessments, are recognized as enhancing the chemotherapy care pathway for patients.

Patients have a fundamental and ethical right to determine what happens to their bodies, and consent is central to all aspects of healthcare delivery. When gaining valid consent, the nurse must be sure that the patient is a legally competent person and gives consent voluntarily after being fully informed of what they are consenting to (NMC [178]). Written consent must be obtained before chemotherapy is commenced and every time the patient is changed from one protocol/regimen to another. The National Chemotherapy Board released guidance related to the use of national regimen‐specific chemotherapy consent forms which incorporates guidance on the process of providing information and gaining consent (NCB [164]). Information regarding the process of auditing consent compliance is also provided within the document. Electronic scanning of consent forms into the patient's medical record is advocated and utilized in many organizations. However, if the organization is not paperless, one copy of the consent form is kept in the medical notes while the other is given to the patient (NMC [178]).