Sustaining colorectal cancer nurses’ specialist practice

© 2 01 4 M A H ea lth ca re L td The specialist nursing role is well established within coloproctology, with approximately 500 colorectal cancer clinical nurse specialists (CRC CNSs) working across the UK. The CRC CNS is regarded as a core member of the colorectal cancer multidisciplinary team. While the details of the role vary, most CNSs have taken on responsibilities that were formerly the preserve of their medical colleagues, such as pretreatment and follow-up clinical care. In general, specialist nurses have a much greater role in the delivery of health care than they had 5 years ago (Macmillan Cancer Support, 2011). GPs and consultants are now more likely than ever to refer patients to specialist nurses (Santry, 2011; Vidall et al, 2011). Owing to existing NHS pressures to deliver timely, cost-effective cancer care, the CRC CNS is often expected to crisis manage patient care to avoid complaints, clinical incidents, and/or a service breach, as well as take the lead on service improvement issues. In addition, an increased incidence and a doubling of 5-year survival rates over the last 40 years has translated into a greater number of people living with and beyond bowel cancer. Therefore, CRC CNSs are addressing the care needs of those living through a more complex and much extended treatment pathway. The continued financial cutbacks imposed by many NHS Trusts have put specialist nursing roles back under the spotlight. While this threat might seem less acute than that in 2006—when nearly one in four specialist nurses faced the risk of redundancy—it is apparent that, today, many specialist nurses are being asked to take on additional responsibilities and often fill shortages in other settings within their Trust (Royal College of Nursing (RCN), 2010). This lack of investment in specialist nursing roles was highlighted in the RCN’s Frontline First campaign (RCN, 2012). To assess the effect these changes may have had on the CRC CNS role, a small email survey of members of the National Colorectal Cancer Nurses Network (NCCNN) was conducted. Its aim was to ascertain perceived levels of organisational support in sustaining the intensified clinical demands now experienced. This paper will discuss Abstract To function optimally in specialist practice, colorectal cancer nurses require sufficient resources as well as organisational support. The authors examined how well this is borne out in practice by conducting a small electronic survey with members of the National Colorectal Cancer Nurses Network in December 2013. Feedback from the 25 colorectal cancer nurse specialists (CRC CNS) who responded highlights that over half (60%) of the nurses perceive their services to be inadequately resourced. Many stated that their services were being stretched beyond their capacity to respond. Despite the majority identifying a need for additional staffing within their service, nearly all respondents were experiencing difficulty in securing such provision. In addition, many felt that their role was under threat. There was general agreement that managing increasingly complex colorectal cancer care pathways with inadequate administrative support was not sustainable. The implications of these findings are discussed by examining the contribution CRC CNSs can make and offering recommendations to sustain the CRC CNS in practice. Sustaining colorectal cancer nurses’ specialist practice