 |  |  | | | THE NEW AGE OF NURSE CONSULTANTS IN HAEMATOLOGY | | | | |
| |  | |  Jackie Green
Release Date: 1 December 2004
Jackie Green is Lead Cancer Nurse and Nurse Consultant for Haematology at the Mayday Healthcare NHS Trust. We find out how she is helping to improve services and bring nurse expertise to the region.
The introduction of Nurse Consultant posts is intended to help provide better outcomes for patients by improving services and quality, strengthening clinical leadership and providing new career opportunities for expert practitioners.
The overall purpose of Jackie’s role is to develop and support, through expert practice, the care of patients with haematological cancer and to provide a leadership and consultancy function for the development of all cancer services.
Jackie works at both regional and local level. She maintains close links with her nursing colleagues and visits the haematology day care unit everyday. Since the inception of her role, the unit has really developed with services in day care becoming more structured. She said: “Patients who required planned assessment ended up attending a busy day care unit where the environment was not always conducive to undertaking a detailed assessment and consultation.”
Jackie now runs her outpatient clinic once a week. Patients are referred from the nurse-led day care service, from consultant referrals for new patients or from shared care patient follow up with haematology consultants. Jackie said: “The patient disease status is very varied and broad — ranging from management of bone marrow failure to that of relapsed disease, both for malignancies and benign disease.”
The clinic has been particularly successful for patients with ongoing treatment. She said: “Patients completing chemotherapy used to be discharged from day care. Now I can assess them at their follow up appointment. We discuss quality of life issues and ensure patients receive guidance, intervention and support. They are given appropriate referrals so that they can restore and improve their lifestyle.”
Jackie added: “The role of the nurse consultant and haematology day care unit has allowed the majority of treatment to be administered as an outpatient or day case, limiting the number of bed occupancy days and improving patients’ quality of life.”
The authority of nurses to prescribe medication is a national initiative and Jackie is eager that haematology nurses embrace this. Awaiting the national formulary to be extended, she said: “In haematology, it will be implemented initially via clinical management, and allow nurse prescribing to take place during my ward rounds, in day care and in my clinic.”
She said: “As a nurse consultant my clinical expertise allows me to discuss the appropriate use of medication and alternatives. Polypharmacy for many patients is a problem and as a nurse I will consider an holistic approach to rationalise medication appropriately.”
Some of Jackie’s work focuses on securing the dynamics of the multidisciplinary team (MDT) identified in the NICE Improving Outcomes Guidance for Haematology, eg the use of visual systems like video links.
The job is very much at the interface of different levels of healthcare professionals. Alongside the director of nursing, she is currently working with the cancer centre in setting up a cancer genetics clinic for patients with a family history of cancer with potential genetic links.
So far, Jackie feels that the nurse consultant role has enabled her to exercise clinical leadership; given her an opportunity to set standards; and worked towards and develop best practice amongst nursing staff at the trust. This is something she hopes will benefit patients region wide.
Nurse Consultant Role:
 | The role development of nurse consultant is always ongoing |
| Direct patient referral to nurse consultant clinic reducing waiting times for patients |
| Improved follow-up for patients post chemotherapy |
| Working closely with workforce education confederation and primary care |
| Developed patient information centre |
| Undertake physical examination improving the total care for patients in nurse consultant clinic |
| Development of nurse prescribing in the acute trust within haematology and oncology |
All in a day’s work
Extract from Jackie’s diary: Friday
07.30hrs… Responds to emails:
| Communicate with cancer service improvement team regarding video links at MDT. |
| Communicate with Nurse Consultant in primary care to discuss deep vein thrombosis service. |
| Communicate with director of nursing about nurse prescribing, arrange conference attendance and provide report on my plan for nurse prescribing for the Trust.
|
08.30hrs…
| Visited haematology day care unit. Discussed with staff patient attendance, care planning and potential problems. |
| Cannulated a patient which nursing team considered “difficult to cannulate”. |
09.00hrs…
| Outpatient clinic (once a week). |
12.00hrs…
| Bleeped by DoN, asked to attend an impromptu meeting to discuss: Nurse prescribing ― for my Trust update and preparation of report |
| Cancer Genetics clinics ― details for setting up |
13.00hrs…
Review with junior sister of patients from haematology daycare who require expert practitioner, eg:
| Arrange admission for patient with progressive disease for symptom management and consideration of alternative chemotherapy |
| Patient with autoimmune thromboyctopenia presents with continued bleeding and response failure on prednisolone. Discussed further treatment options with Consultant Haematologist and arranged for administration of immunoglobulin. |
Prepared weekend management plans for in-patients and emailed to on-call clinical haematologist.
14.15hrs…
Attended Cancer Centre to discuss education and training programme for staff caring for patients with bone marrow suppression (initiative with District General Hospital and Cancer Centre).
16.00hrs…
Prepared presentation for international conference held in two weeks.
17.00hrs…
| Return to Trust to respond and write emails; |
| Request to sit on interview panel as an external interviewer |
| Request to review clinical nurse specialist job descriptions |
| Request to talk at a national conference |
| Requesting response to agenda for change training |
| Send emails inviting appropriate staff to attend ‘Nurse prescribing working group’. |
Reference documents which have contributed to the nurse consultant role:
| Scope of Professional Practice (UKCC, 1992) |
| Code of Professional Conduct (UKCC, 1992) |
This interview with Jackie also appears in the Nursing Leukaemia newsletter No.2 2004
|
|
|
|
|
