Val Aston and Claire Garman Cancer Care Cymru

1. Val Aston and Claire Garman Cancer Care Cymru Has the specialist nurse left the building?

2. Background • Concerned about the demise/erosion of specialist nurse posts • In unique position because of charity’s ‘specialist nurse’ focus to ‘fight the corner’ • Increasingly it is charities who are funding specialist posts • Conscious that ££s talk and therefore how much are specialist nurses worth?

3. ‘In an era of deficit-laden NHS trusts, one of the most vulnerable groups for cutbacks are specialist nurses.’ (Dinsdale and Waters 2006)

4. RCN Specialist Nurse Survey 2008 11% have been downgraded 23% have been told they could face redundancy 45% have been asked to work outside their specialist role to cover staff shortages 47% have been asked to justify their posts (Nursing Standard 2008)

5. ‘Little progress has been made in economic evaluation of specialist cancer and palliative care nursing’ Douglas, Normand et al (2003) International Journal of Palliative Nursing

6. Some of the arguments presented against specialist nurses • They are expensive to employ • Seen as a ‘luxury’ by many managers • Limited research demonstrating ‘value for money’ in terms of measured outcomes • De-skill generalist nurses

7. On the other hand • Patients and families ‘sing our praises’ • The NHS Modernisation Agency – 10 High impact changes recognises the cancer CNS as key to its implementation. Similarly other key documents • Evidence of benefits now emerging

8. ‘It is important that awareness is raised of what specialist nurses actually do and the contribution they can make to improving patient care and the patient experience’ (Richard Jones interim director of the Royal College of Nursing Wales 2008)

9. What did we do? • Discussed with research manager at Trust • Reviewed the literature to try and identify any ‘appropriate’ measuring tools • Conducted pilot study with local sample of specialist nurses from both NHS and voluntary sector

10. Pilot design • Recruited sample of 10 specialist nurses • 3 phone calls to each nurse during one week • Asked………‘what have you been doing for the past two hours’? • Responses and comments entered on recording sheet

11. Data analysis • Responses entered onto spread sheet • Placed in logical categories (20 identified) • 199 incidences recorded

12. Results of pilot 9.6% 4.0% 4.5% 29.3% 4.5% 19.7% 28.3%

13. Main findings related to communication! 81% • Communicating with Health Professional = 29.3% • Consultation with patients including Nurse Led Clinics = 28.3% • Phone calls to patients = 19.7% • Communication with family/carers = 4.5%

14. Others • Education • MDT Meetings • Staff Support at HR Meetings • Review of notes • Cover cancer ‘help line’ • Ward visit • Attended pharmaceutical meeting • Travel • Meeting with Assembly Minister for Health • Attending staff meeting • Fund raising administration • Research/audit

15. ‘Advanced practice’ roles identified • Nurse Led Clinic (work independently leading a team) • Carry out physical examination/s • Prescribing chemotherapy/associated drugs • Inserting central line and administering chemotherapy within nurse led clinic = 20%

16. So what next?….. • Collaborative study planned with Cardiff University exploring content and outcomes of specialist oncology nurse consultations with patients/families • Consider replicating the pilot in other areas following more in depth analysis • Economic assessment tool?

17. Points for discussion • How do we best evidence the need for further investment in the Nurse Specialist Role? • Are we in danger of following a medical role in terms of advanced practice? • Should specialist posts increasingly be funded by charities?

18. Thank you