EONS Cancer Nursing Index 2020

EONS Cancer Nursing Index 2020

In the RECaN project EONS highlighted important differences in cancer nursing across Europe. EONS Cancer Nursing Index 2020 was developed by the EONS Advocacy Working Group to illustrate the development and status of this profession in Europe. The index (with scores from 0-100) includes 22 items covering the following dimensions: Education and Career Development, Patient and Occupational Safety, Recognition, Working Conditions and Impact and Workforce.

The Index is based on data from the following sources;

  1. A range of data bases including the EONS Survey on Patient and Occupational Safety (anonymous survey, available in 9 languages, with over 650 responses from cancer nurses in 40 countries)
  2. Interviews with leading cancer nursing experts. Nurses from 40 of 42 invited countries participated
  3. Work force statistics (from ec.europe.eu/Eurostat and OECD)

A scoring system was developed by EONS Advocacy Working Group to reflect the level of development for the different Index dimensions/items. For items with a variety of responses from the same country, the most frequently reported response was used. The purpose of the Index is primarily not to rank some countries as better than others but to illustrate cancer nursing profiles, differences and areas in need of development. The Index could be used in the development of cancer nursing in each country but also for general European progress.

Five dimensions:

Education and Career Development

This dimension, with 5 items and a maximum score of 23, includes each country’ cancer nursing education levels and academic development, and also the level of established advanced practice roles and recognition of EONS Cancer Nursing Education Framework.

Patient and Occupational Safety

This dimension, with 8 items and a maximum score of 36, covers access to safety guidelines and personal protection equipment (PPE) for handling cytotoxic drugs, systematic testing of occupational exposure, guidelines and exposure for pregnant and/or breast-feeding nurses, whistle blower policies, formal training before administering cytotoxic drugs and finally, frequency of nurses preparing cytotoxic drugs.

Working Conditions and Impact

This dimension, with 4 items and a maximum score of 20, includes level of adherence to the European Working Time Directive (EWTD), risk of negative consequences for nurses denying handling cytotoxic drugs during planned pregnancy/breast feeding, frequency of beds closed, or cancer treatments delayed due to cancer nursing shortage.


This dimension, with 4 items and a maximum score of 18, includes the countries’ level of establishment of nurse-led care, national cancer plan including nursing issues, proportion of cancer centers with a Board position dedicated to cancer nursing and whether a national cancer nursing organisation is established.


This item includes 1 item (maximum score 3) and consists of data on the number of practicing nurses/1000 citizens (ec.europe.eu/Eurostat and OECD).

Among the included countries, the total scores of the EONS Cancer Nursing Index 2020 vary between 16 and 78 (maximum score 100). Ireland obtained the highest total score and we congratulate the Irish cancer nurses for this achievement. Our conclusion is that cancer nursing needs to be strengthened in all 38 countries, to guarantee high quality and safe cancer care. We found a large variation in scores between the five dimensions, illustrating the differences in cancer nursing profile between the countries. While some countries scored higher in education and career development and/or safety, others scored higher on working conditions and impact.

Overall results

Communication and National Cancer Nursing Profiles

The EONS Cancer Nursing Index 2020 is important for the continuing work to achieve EONS’ vision that cancer nursing will be recognised by the cancer community and national- and European-level policy makers, as a profession with specialised training and qualifications available across the continent. Each country’s national ECNI profile can be downloaded by clicking on the country name in the Further Information section on the right-hand side of this page. It is important to point out that the number of responding nurses in ECNI vary between countries and regional differences occur. The results should be viewed as a snapshot of each country’s cancer nursing development, viewed from the profession. Leading cancer nursing experts were invited to respond to the results before these documents  were published. Any national cancer nursing society that wishes to learn more or discuss the results is welcome to contact EONS Advocacy Working Group. The plan is to update the ECNI in 2022 with comparisons. 

Copyrights © All rights reserved from EONS Advocacy Working Group / Published on 18 May 2020