UK prostate cancer care is at a critical juncture. At the start of 2020, it was confirmed that prostate cancer had overtaken breast cancer as the most commonly diagnosed cancer in England – ten years ahead of previous estimates. The news report a deeper context around recent research from Prostate Cancer UK that revealed a worrying shortage of prostate cancer nurse specialists. The study highlighted a shortfall of 300 specialist urology nurses, with only six CNSs for every 1000 people diagnosed with a urological cancer in England. The implications are significant – commentators say the lack of numbers is negatively affecting care, fuelling widespread variation across the country and depriving some patients of expert support. The future is equally troubling, with 41% of prostate CNSs planning to retire in the next decade and general nursing vacancy rates currently somewhere between 8-12%. These figures are a great shame, not only for patients – who very much value their engagement with specialist cancer nurses – but also for our profession. With urological cancer services facing unrelenting pressure, nurses can play a vital role in relieving some of the burden on clinical teams. For the sake of patients all over the country, we cannot risk wasting the opportunity.
The nurse’s code: putting patients first
Working as a specialist urology nurse – in my case a surgical care practitioner – is hugely rewarding. It fulfils all those reasons why many of us first become nurses, most notably that desire to help patients at times when they’re poorly, scared and vulnerable. Evidence – both documented and anecdotal – shows that nurse specialists, in all their various guises, can significantly improve the patient experience. Those of us at the coalface already know this, because our patients tell us. However, the rewards of specialist nursing go much further. As demand for urology services increases and hospital resources become stretched, specialist practitioner roles offer real scope for professional development as aspirational nurses upskill to help clinicians and fill gaps in care. My own story illustrates just what’s possible, showing how advances in prostate cancer care are not only transforming patient pathways, they’re stimulating new opportunities for nurses to enhance their value to the multidisciplinary team.
My journey as a surgical care practitioner at North Bristol NHS Trust began three years ago. Fundamentally, the role means being a ‘familiar face’ to patients, supporting them through the whole pathway and providing continuity, contact and expertise before and after surgery. The bulk of my work has historically been to assist robotic surgery (typically prostatectomies) in theatre. However, having observed the pressures being placed on our service – and understood the need to improve our cancer pathway – I quickly sought opportunities to expand my role to improve the patient experience.
It wasn’t easy. The dynamics of a busy urology team – where multidisciplinary teams do fantastic work to support patients – mean that identifying opportunities to add value without ‘crossing boundaries’ or stepping on toes is difficult. My motivation was simple; I wanted to help. I knew that there was strong evidence that CNSs play a huge part in improving the patient experience, helping to avoid delays right across the pathway. However, I also knew that making those improvements is a collective responsibility – so I tenaciously kept on looking for opportunities where I could supplement the wider teams and add greater value myself.
In 2019, that opportunity emerged. One of our uro-oncology surgeons offered me the chance to attend a training course in conducting transperineal biopsies under local anaesthetic (LA TP). LA TP biopsies are an alternative to traditional (transrectal ultrasound) TRUS biopsies, which have been shown higher cases of infection and sepsis and can yield inaccuracies in identifying potential cancer cells. Until recently, hospitals would only offer a transperineal biopsy if other health problems meant a patient couldn’t have a TRUS biopsy, because they required a general anaesthetic, or if previous negative TRUS biopsy with increasing PSA, or if a more thorough biopsy was needed. However new innovations mean that LA TP biopsies can now be carried out by nurses in outpatient settings using advanced freehand technology – PrecisionPoint. As such, many trusts, including ours, are starting to eliminate TRUS biopsies and replacing them with the LA TP approach.
The LA TP training, which fundamentally taught me how to carry out the new procedure, provided an opportunity to develop distinct value that could make a difference to the patient experience. It gave me the chance to expand my role with a highly specialist skill – and in doing so, it enabled me to fulfil my objective to be involved at every phase of the pathway. I knew that by upskilling, and bringing new capabilities to the urology team, I would be able to make a real contribution to improve the patient experience – and also help the centre potentially speed up diagnosis.
Following the course, the trust arranged for further training with an advanced nurse practitioner from South East London Accountable Cancer Network, Jonah Rusere, who supervised me while I conducted LA TP biopsies for three full patient lists. This, along with shadowing one of our own consultants, gave me the confidence and competence to become a capable HCP. I subsequently carried out my own list independently in September 2019 and been supervised in several lists by two of our own consultants. Alongside that, I’ve also been learning to interpret MRI scans. This will help me become an expert in identifying and targeting prostate lesions.
With my enhanced role – which also encompasses a range of patient engagement prior to, and beyond, biopsy – I hope I am making a valued contribution to the transformation of prostate cancer pathways at North Bristol hospital. Moreover, it shows the important part that nurses can play in improving services, reducing delays and – ultimately – helping patients. These are opportunities that every aspirational nurse dreams of when they take their first steps into nursing – and they’re there for the taking when the circumstances are right.
Making the journey
So how do you get there? My journey has relied on ambition and steely determination, as well as the unwavering support of colleagues and a small slice of serendipity with the emergence of LA TP. There have, of course, been challenges along the way; driving change and rethinking pathways and processes is always difficult in complex acute environments. However, with patience and perseverance, opportunities to make a difference will often emerge.
Those opportunities will naturally be situational – they’ll depend on the unique circumstances that drive every trust. However, if you’re looking to progress into a specialist urology nursing role, there are certain qualities that give you the best chance of success. Here’s my advice:
- Immerse yourself in the desirable area and be willing to take on new skills. Remember that you’re always learning. If you want to be a specialist practitioner, every day is a school day.
- Work hard and don’t give up. My thirst for improvement meant working out of hours and on days off to build my knowledge and expertise. It was worth it.
- Be confident. Rare though it is, there will always be scepticism and old-school views that nurses aren’t qualified to perform certain clinical tasks. But we’re there to help, and if the regulations permit it and we’re properly trained, there’s very little we cannot do. If you need to prove your worth – to others, or simply to yourself – audit your work, document it and share it at MDT meetings. You’ll soon be able to show that you’re as good as anyone else.
- Keep your eyes on the prize. Remember that everything you do is for one reason alone: to help patients. If you stick to that, you won’t go far wrong.
Submitted by Beatriz Mora, surgical care practitioner at North Bristol NHS Trust.