Editorial Rheumatology nurse specialists — do we need them ?

At a recent demonstration by health care staff in Leeds, the banner held by three specialist rheumatology nurses read 'People with arthritis need staff who understand it – cuts are causing chaos'. So what has happened that has caused these normally calm and hardworking nurses to protest so vociferously? As is the case with many specialist nurses, their posts are under threat. This is rather perverse, given that the Musculoskeletal Services Framework, recently published by the Department of Health, specifically mentions that specialist nurses/practitioners are necessary to run monitoring clinics and provide patient education and support to enhance self-management [1]. The heart of the problem is the funding deficit, as hard pressed Trusts struggle to comply with government instructions to balance their books. Simultaneously, job evaluations and pay awards emanating from the Agenda for Change (AfC) [2] are being implemented. AfC is timely for Trusts as it has precipitated a review of roles and bandings, and specialist nurses'/practitioners' posts have been identified as potential areas for cost savings; cutting posts not only reduces the wage bill but also helps to resolve some of the huge pensions deficits. So are Trusts right to target these posts? What is the contribution of rheumatology nurse specialists/practitioners that is so important that their posts should be protected? In other words do we need them and should we keep them? To answer these questions adequately, it is necessary to describe the role of rheumatology nurse specialists/practitioners and assess the evidence for their effectiveness. As no distinction is made between the functions of nurse specialist and nurse practitioner within rheumatology nursing, the term rheumatology nurse specialist (RNS) will be used. Publications about the role of United Kingdom RNS started to appear in the early 1980s. Nurses in Leeds who were undertaking clinical drugs trials began taking responsibility for a wider area of patient management. This was because patients who had completed their trials and had been returned to the general rheumatology clinics, began seeking further consultations with the nurses [3, 4]. It was decided that nurse-led clinics would run alongside a rheumatologist's clinic, and that the nurses would manage stable patients and provide education, advice and support for more difficult cases. A small-scale evaluation showed that patients valued this experience [5]. During the 1980s and 1990s, more rheumatology centres employed RNS and by 1992, a nationwide survey returned by 51 respondents identified their main functions to …