Beatriz Mora, Surgical Care Practitioner at North Bristol NHS Trust, describes how specialist urology practitioners are helping to transform prostate cancer care – and why the roles are perfect for any aspirational nurse who wants to improve the patient experience.

At the dawn of a new decade, UK prostate cancer care is at a critical juncture. This year began with confirmation that prostate cancer has overtaken breast cancer as the most commonly diagnosed cancer in England – ten years ahead of previous estimates. In this context, recent research from Prostate Cancer UK revealing a shortage of prostate cancer nurse specialists is highly concerning. The study highlighted a shortfall of 300 specialist urology nurses, with only six clinical nurse specialists (CNS) for every 1000 people diagnosed with a urological cancer in England. The implications are significant – commentators say the shortage is negatively affecting care, fuelling widespread variation across the country and depriving some patients of expert support.

This problem is set to intensify in years to come, with 41 per cent of prostate CNSs planning to retire in the next decade and general nursing vacancy rates currently somewhere between 8-12 per cent. These figures are a great shame, not only for patients for whom there is great value in 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 the reasons why many of us first become nurses, the desire to help patients when they are 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 clinicians and fill gaps in care. My own story illustrates just what is possible, showing how advances in prostate cancer care are not only transforming patient pathways, they are stimulating new opportunities for nurses to enhance their value to a multidisciplinary team.

My story

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 seeing the need to improve our cancer pathway, I quickly sought opportunities to expand my role to improve the patient experience.

It was not easy. The dynamics of a busy urology department make it difficult to identify opportunities that add value without ‘crossing boundaries’ or stepping on toes. 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 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 higher cases of infection 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 could not have a TRUS biopsy, 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 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 help the centre potentially speed up diagnosis.

These are opportunities that every aspirational nurse dreams of when they take their first steps into nursing

Beatriz Mora, Surgical Care Practitioner, North Bristol NHS Trust

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 have 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, when the circumstances are right, they are there for the taking.

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 will depend on the unique circumstances that drive every trust. However, if you are looking to progress into a specialist urology nursing role, there are certain qualities that give you the best chance of success.

My advice:

  1. Immerse yourself in the desirable area and be willing to take on new skills. Remember that you are always learning. If you want to be a specialist practitioner, every day is a school day.
  2. Work hard and do not 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.
  3. Be confident. Rare though it is, there will always be scepticism and old-school views that nurses are not qualified to perform certain clinical tasks. But we are there to help, and if the regulations permit it and we are properly trained, there is 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 will soon be able to show that you’re as good as anyone else.
  4. 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.