Publish date: 15 March 2022
Clinical Nurse Specialists (CNSs) are the backbone within services for patients undertaking treatment for cancer.
While their tasks and functions can be very different, there is always on common denominator in their role – care.
Now a celebration across the UK is showing how the public and other health professionals care about them and their huge contribution to the NHS, with the launch of their own dedicated day – National Cancer CNS Day.
The event will shine a light on what cancer CNSs do and applaud them for their work – including in Cheshire and Merseyside – either in primary, secondary or tertiary care, in a community setting or in the private sector.
CNSs are registered nurses who are clinical experts in their speciality area, be it by sector or tumour type. They treat and manage the medical concerns of patients – and their families and loved ones – and promote health and wellbeing in those they care for.
CNSs are senior nurses with postgraduate qualifications and acquired specialist knowledge to support cancer patients. They hold regular clinics to support patients through their cancer diagnosis, treatments and follow-up care, sometimes for years afterwards.
Over the last few years, Macmillan Cancer Support has stated that around 30% of the UK’s specialist cancer nursing workforce will retire in the next 10 years, while also highlighting that CNS numbers will have to double by 2030 to meet the needs of an ageing population.
To promote the cancer nursing profession and to thank cancer CNSs who, alongside all health professionals, have worked tirelessly throughout the pandemic, the first National Cancer CNS Day has been launched by Greater Manchester Cancer. The day has the support of Health Education England, Macmillan UKONS Oncology Nursing Society and the Royal College of Nursing.
It is hoped the event on Tuesday, March 15th, will be held annually, with activity on social media channels across the UK, shared with hashtag #NationalCancerCNSDay.
CNS Sharon Boughey is a Macmillan Breast Care Nurse Specialist who works in a team of four nurses with Gaynor Power, Julie Glynn and Louisa Baird at St Helens and Knowsley Teaching Hospitals NHS Trust.
Her role is to be a key worker across the whole cancer care pathway, which involves supporting both screening and symptomatic patients with a diagnosis of breast cancer, throughout their treatment and beyond.
She says: “I work as part of a multidisciplinary team and act as an advocate for the patient, explaining pathology reports and discussing the rationale behind treatment decisions. Written information is always provided.
“I play a crucial role in supporting patients, emotionally, physically and psychologically throughout their cancer pathway.
“I offer individualised holistic needs assessment and plan care appropriately, signpost to relevant services, educate both patient and their families and actively promote health and wellbeing.”
Sharon adds: “As a team we provide a Supported Self-Management Programme, which allows patients to take an active role in their recovery. With the information given to each patient from their specialist nurse they are then able to make positive choices about their health, manage the physical and emotional impact of breast cancer and its treatments and make long-term, positive changes to health behaviours.”
Laura Parry is a Macmillan Acute Oncology Specialist Nurse in a team of two CNSs at Arrowe Park Hospital at Wirral University Teaching Hospital NHS Foundation Trust (WUTH).
Her role consists of reviewing the trust’s cancer patients who have many different types of disease. She says: “Many patients are on treatments such as chemotherapy, radiotherapy, hormone therapies and immunotherapy. Some patients are poorly on admission due to these treatments and it is important that their oncologist is aware so oncology advice can be given to the ward doctors if required.
“We go to the wards to review these patients and continue with support and advice during their stay in our hospital and keep their oncologist updated.”
Laura also helps to support and monitor cancer of unknown primary patients in the own homes. “We organise any benefits they are entitled to and, if appropriate, refer them to services such as the community specialist palliative care team,” she says.
Kelly Bradshaw is another CNS at WUTH, working in the busy dermatology department at Clatterbridge Hospital. In the 15 months she has been working there, she says she has had a “great deal to learn”.
“My role consists of informing and supporting patients with varying degrees of skin cancer,” she says. “I do several clinics a week, one of which is a results clinic where I give the cancer diagnosis and then discuss treatment options with support.
“The rest of my week is filled with follow-up clinics, which include full skin checks to rule out any lesions of concern and, for the more involved cases, keeping up to date with all CT scans and treatment plans. There is a multidisciplinary team (a team of all clinical disciplines looking after a patient) meeting once a week which I attend along with the senior CNS Lianne Jackson.”
Kelly says that no two days are the same, “which can be challenging yet also rewarding”.
“There are only the two of us as CNSs* working under the Macmillan umbrella but we manage the workload well between us,” she says. “We are there from the beginning of a person's cancer journey all the way through the process with them and I am proud to be a part of this team.”
Grace McGrath, a Macmillan Urology Nurse Specialist, is part of the Urology CNS team at WUTH, promotes “the philosophy of person-centred care by supporting my patients, their families and carers throughout their journeys”.
He jobs is to help diagnose, support and deliver the best possible patient outcomes, including providing literature for patients who are diagnosed with urological cancers, including prostate, bladder, testicular, kidney and penile cancers.
She says: “My role begins with a referral from GP with a suspected cancer. Following an initial triage, I organise timely diagnostic tests and procedures to help confirm the nature of the disease or in good outcomes, all clears.
“Following a diagnosis, I offer holistic needs assessments to ensure that my patients get the relevant information, support and personalised care they need.
“I am always at the end of the phone to offer advice and expertise to answer any questions or issues they may have. I use my knowledge in the urology setting to be an advocate for their care.”
The Urology CNS Team are pictured above, from left to right, Beverley Rogers, Gillian Riley, Nerys Jacob, Grace McGrath, Jackie Williams, Gemma Virgo and Emma McClaren.
There are currently 22 CNSs working across 10 different cancer specialties at the Countess of Chester Hospital NHS Foundation Trust (COCH).
One is Helen Boothman, the CNS who supports women with gynaecological cancers from diagnosis through to living with and beyond their cancer.
“I act as an advocate, intermediary and facilitator to ensure women are kept well informed and supported at all stages of their cancer pathway,” says Helen.
She believes that open, honest and timely communication of her knowledge of these cancers is essential. “For me, it is paramount that I establish a good open relationship right from the start,” says Helen. “Women need to know they can trust, rely and depend upon me for support whenever they need it. It is my privilege to help women through this difficult time in their and their loved ones lives.”
Helen helps women with a gynaecological cancer in the following ways:
- Providing practical, emotional, psychological and signposting support from diagnosis through to living beyond cancer
- Acting as principal point of contact – being available and contactable at any time
- Ensuring tests, results and appointments happen in a timely way
- Imparting knowledge and expertise in gynaecological cancers, tailoring this to individuals’ needs
- Advocating for women at MDT discussions and with other departments and treating hospitals, e.g. Liverpool Women’s Hospital and The Clatterbridge Cancer Centre
- Giving information on local and national sources of support and help
When Jo Martin, Macmillan Skin Cancer Specialist Nurse, started as a CNS 13 years ago the role was brand new.
One of the things she has enjoyed most over the years since is seeing how both her role and the treatment options available have transformed during that time. Jo, who works at COCH, says: “It was a new role when I started and it has evolved so much over time by seeing patients in clinic, assessing them and giving the support they need. I love what I do.”
In Jo’s specialty, she often sees her patients for follow-up appointments, sometimes for up to five or 10 years afterwards. Developing close bonds with patients and providing that continuity of care is one of the most rewarding aspects of her role, but she also relishes working so closely with her medical colleagues.
Jo adds: “The consultants I work with in dermatology are extremely supportive and inspirational. Working alongside them is fantastic and extremely rewarding.”
When asked what qualities a CNS needs, Jo says: “I think you need compassion, you need understanding and you need to put your patient first. You need to take their views into consideration with everything that you do.”
Kate Holloway, Lead Nurse for Upper GI Cancers at COCH, enjoys the variety in her day-to-day CNS role looking after patients with cancers of the oesophagus, stomach, pancreas, liver and gallbladder.
With some of her patients requiring treatments in other centres, Kate often provides support and liaises between colleagues working across the Cheshire & Merseyside Cancer Alliance.
Kate says: “As a region, we collaborate really well and it’s excellent for our patients because they’re always getting that specialist input.”
Learning improved communication skills, both with other colleagues and patients, is one of the things Kate has most enjoyed about being a CNS. She adds: “I’ve been a nurse for 20 years this year. I would say I’ve developed more over the last 10 years, both as a cancer clinical nurse specialist and palliative care nurse, than I did in the first half of my career.”
Helen Thomas, Lead Cancer Nurse at COCH, is urging any nurses who think they would like to become a CNS to find out more about this rewarding role.
Helen says: “Any nurses who are interested in being a cancer specialist nurse should contact the relevant specialist nurse in their organisation and either spend time with them or find out more about it.”
The Clatterbridge Cancer Centre NHS Foundation Trust has around 80 CNSs, who work across a number of tumour types, including staff who work in palliative care and research, delivering a number of new treatments to cancer patients at the new Clatterbridge Cancer Centre - Liverpool hospital.
Below are some of the CNSs at Clatterbridge...
As part of National Cancer CNS Day, Dr Liz Bishop, Senior Responsible Officer at CMCA, and Chief Executive at The Clatterbridge Cancer Centre NHS Foundation Trust, has used a video message to thank Clinical Nurse Specialists across Cheshire and Merseyside.
You can watch the message from Dr Bishop, who once was a CNS, below: