How specialist nurses with ‘extended’ roles are changing the way we provide care for good

The number of cancer diagnoses in the UK is increasing every year, and two-thirds of cancer patients will need to have chemotherapy. In this blog post, Rebecca Johl, senior nurse for oncology and lead chemotherapy nurse, explains how we’ve achieved big improvements in care for chemotherapy patients by introducing an ‘extended’ role for specially trained nurses.  Rebecca and her team have now been shortlisted for a prestigious Nursing Times Award for their innovative, nurse-led chemotherapy clinics. 

Until October 2014, all our patients receiving chemotherapy were seen before each treatment cycle by a doctor in Clinic 8, our oncology outpatient department at Charing Cross Hospital. Patients usually saw a different doctor at each visit and could often have a long wait in the clinic. We decided that we needed a new solution to meet the challenges of an increasingly busy service.

Our solution was a nurse-led chemotherapy clinic which has produced fantastic improvements for patients, as well as for staff and the wider Trust.

We started with a pilot in summer 2014. With the new approach, patients received their chemotherapy in quiet consulting rooms, separate to Clinic 8, run entirely by specialist chemotherapy nurses working in ‘extended’ roles. The specialist nursing team are able to give their patients more time and more individual, holistic care – factors that are very important to our patients. Our nurses have the specialist knowledge of the treatment, its side-effects and toxicities, as well as the core nursing skills that mean we are just as focused on our patients’ general wellbeing and how they are coping.

One of the first things we learned during the pilot was that we needed a more senior chemotherapy nurse to run the clinic and carry out the extended role, as they would be best equipped to deal with more complex questions that patients might have, such as how their fertility might be affected by treatment. From this, the nurse practitioner role evolved. The nurse practitioners are in charge of the clinic as well as looking after patients and supporting more junior chemotherapy nurses.

The pilot was a huge success. This meant we could recruit three more chemotherapy nurse practitioners, and we rolled out the nurse-led clinics fully in October 2014 at Charing Cross and Hammersmith hospitals.

More time with patients

At the nurse-led clinics, patients now get a 30-minute appointment with one of our nurse practitioners instead of a 10-minute appointment with one of the oncology consultants in outpatients. Patients are able to see the same nurse practitioner each time. The nurse practitioners are able to build up relationships with their patients as well as with their families, friends and carers. The longer appointment means that nurse practitioners can go through all the side effects with patients and also discuss how they are coping more generally, for example with the financial side of things which may be affected if they are too unwell to work while having chemotherapy.

More personal care

Nurse practitioners are able to give patients on going, tailored support. The day after a patient’s first cycle of chemotherapy, the nurse practitioner will phone them at home to make sure they are ok and answer any questions they have. This means the patient feels more able to ring the clinic back if they have any worries or concerns in between treatment cycles. The nurse practitioners can often provide advice and support over the phone which means patients are less likely to have to come into hospital. If patients do need to be admitted, they can go straight to the acute oncology unit, where their nurse practitioner will liaise with the acute oncology team about treatment.

More development opportunities for staff

The nurse-led clinics have also had wide-reaching benefits for staff. The nurse practitioners use their expertise to give all chemotherapy nurses on the unit support and informal training as well as working across the Trust to provide more formal education on chemotherapy.

The nurse practitioner role is perfect for those wanting to stay in a more senior clinical role in chemotherapy. Recruiting chemotherapy nurses in London can be very challenging, but by creating this new role we have greatly improved our recruitment and retention of staff.

Improvements that go beyond the clinics

The clinics have had a knock-on effect for the chemotherapy service and on other services in the Trust. This includes reduced waiting times for chemotherapy in clinic and, with more chemotherapy patients able to manage their side-effects safely at home or to be admitted directly to the acute oncology unit if they need further treatment, there is less demand on inpatient beds and fewer A&E attendances.

We have a lot of people visiting us from other hospital trusts as they have heard about our success and want to replicate it.

When the clinic was first developed we only expected to see patients with certain cancers, but we now see patients with all tumour types and patients with some very complex needs. This is because of the trust we have built up with patients and with the doctors with overall responsibility for their care. The clinic has led to improvements for patients and staff that have exceeded all our expectations. We’re really proud of what we’ve achieved.