25 March 2021
Stepping Up: running and coordinating a symptomatic breast cancer service without direct breast surgeon supervision
UKONS are pleased to have had the opportunity to talk to Claire, one of this year’s winners of the prestigious, UKONS sponsored, ‘British Journal of Nursing Oncology Nurse of the Year’ award.
North Devon District Hospital is a small Trust and is the most remote rural acute Trust in England. At the end of 2019, the breast service found themselves at the centre of a ‘perfect storm’. A long-standing associate specialist doctor had recently left and they were unable to recruit a locum breast surgeon to support a single-handed onco-plastic surgeon. Additionally their breast surgeon announced her need to have a minimum of 10 months leave, commencing in early 2020. The specialist breast cancer nursing team consists of three CNSs (Karen, Claire and Amy) and an Assistant Practitioner (Abi). The CNSs all have medical assessment skills and two are non-medical prescribers.
There was now a challenge to this team to take on the two-week triple assessment clinics and the running and coordination of the symptomatic breast cancer service, all without direct breast surgeon supervision. Neighbouring centres were happy to assist with the governance of putting patients through their MDT’s and offering surgical slots, but due to their own pressures, were unable to provide a replacement whole time surgeon for this period.
As things stood, it would mean that over 1600 new two-week referrals per year would have to travel at least 100 miles as a round trip for their outpatient appointments. The nursing team had the advanced skills needed, a supportive breast radiology team and MDT and they therefore stepped up!
Standing Operating orders were written and approved, patient pathways written and governance arrangements approved with three tertiary centres. A local retired surgeon rallied to the COVID-19 call to help, and came back 2 days a week to perform some basic breast cancer surgery and further reduced the need for patients to travel.
The team are able to see and assess all the symptomatic breast referrals that come into the unit and then present them at the local MDT as their own local patients. They then meet with the patients to explain treatment plans to them and make the appropriate referral. This is a holistic service run in a nurse-led manner.
Some nurses might believe that working in a small Trust means that you are not at the forefront of innovative practice, but this project shows that, with confidence, a high quality, equitable service can be developed and maintained.
Karen, Claire, Amy and Abi are passionate about offering their patients the best possible care and access to services. They pride themselves on giving a personalised patient centred service and are able to offer health need assessments and signpost to appropriate support services from diagnosis throughout the cancer journey.
So…..what advice would they give to nurses aspiring to achieve positive change within their role and wider healthcare? Their advice is this-:
• Believe in yourself and your capability
• Often nurses are the ones dealing directly with the patients, and have a better understanding of the issues and the barriers to health care
• Don’t be afraid to speak up
• Good communication is vital
• Always try to turn a negative situation into a positive one
• Negotiate your terms and conditions prior to taking on extra responsibilities
• Remember the patient should be at the centre of all that we do.
This project shows specialist nursing at its best and is a deserving winner of the BJN award for this year.
For further enquiries, please contact Claire (NORTHERN DEVON HEALTHCARE NHS TRUST) at claire.herlihy@nhs.net