Statistics from Altmetric.com
The role of the lung cancer nurse specialist in the UK is a recent development in response to initiatives aimed at improving the delivery of lung cancer services and it has now become integral to the lung cancer multidisciplinary team (MDT). A small survey in 20001 indicated that there was little strategic planning and evaluation of the role, and until recently definition and training requirements have been lacking. Recent guidelines2 state that all lung cancer units should have at least one specialist lung cancer nurse to support patients and coordinate care between primary and secondary care teams. Despite this, the number, workload and exact duties of these practitioners remain undefined. We therefore conducted a questionnaire survey to determine the current profile of lung cancer nurses working in the UK, which should help plan future roles of these clinical nurse specialists.
A three section questionnaire (focusing on manpower, clinical and non-clinical activities) developed and piloted with members of the Scottish Lung Cancer Nurse Interest Group Committee, was sent to all 250 lung cancer nurses identified through the National Lung Cancer Nurses Forum and the Roy Castle database: 212 responded (85%).
Of the 130 lung cancer units represented by this survey in 2005, 15 (12 %) had three or more nurses, 47 (36%) two nurses and the remaining 68 employed one or less whole time equivalent (WTE) nurse. Of those who worked in isolation, only 18 (26%) had formal arrangements for holiday or sickness cover. Although the median number of new cases seen per WTE nurse was 142 per year (interquartile range 117–200), nurses in 49 (38%) units admitted that they had insufficient capacity to enable all referrals to be seen. Only 96 (45%) had any secretarial support (median 5 h per week).
The 125 nurses (66%) working in cancer units carried out more varied duties than those in cancer centres (p<0.01). Table 1 shows the most to the least frequent clinical activities and the degree of involvement by the specialist nurses. Of the non-clinical activities, nearly all (>90%) were involved in education, audit, service and personal development. However, only half were able to carry out research because of a lack of dedicated time and pressure of work. Approximately 50% had management responsibility for other colleagues, and a similar number spent time collecting clinical data for and coordinating the MDT meetings. For a number of nurses, this included populating clinical databases.
Following implementation of the UK National Cancer Plan in the wake of the Calman–Hine Report,3 there has been a rapid expansion in services aimed at improving the care of lung cancer patients. As part of this, there has been an increase in the number of lung cancer nurses, from 130 in 20001 to 250 identified in the current study. The results of our survey show a wide variation in the duties and allocation of lung cancer nurse specialists within cancer services in the UK. Many nurses have a large workload, poorly structured job plans with inadequate secretarial support. Although most were involved in “front end” activities, their lack of involvement in the ongoing care of lung cancer patients post diagnosis was disappointing, especially since nurse led follow-up clinics4 and the establishment of nurse run breathlessness clinics5 have been shown to be effective means of improving the quality of life for lung cancer patients. Nevertheless, the survey did demonstrate the wide range of services that lung cancer specialist nurses can now provide and there is scope for rolling out these skills to more nurses in more MDTs, easing the burden on hard pressed medical staff. However, the current culture of the NHS makes it difficult for health care commissioners to sanction the appointment of new nurses unless this is linked to an improvement in the achievement of targets, which are not usually quality based. The development of a national job specification tailored to lung cancer patient’s needs may help to improve this aspect of care for these patients, and would help commissioners to support this aspect of the Cancer Reform Strategy.
The authors acknowledge the financial support and encouragement given by the British Thoracic Society Lung Cancer and Mesothelioma Specialist Advisory Group. They would like to thank all members of the National Lung Cancer Nurses Forum and the Roy Castle Centre database who completed the questionnaire. They would also like to acknowledge Dr M Nicolson for her support and encouragement to publish data, and Nikki Stewart who helped to collect and enter the data.
Competing interests: None.
*LB sadly died in July 2008.