Push to promote profile of cancer nurses in Europe
Cancer nursing is well-developed in the UK but in some European countries there is little recognition of its value. An ambitious new initiative is attemptign to raise the status of the specialty across Europe.
Cancer nursing is well-developed in the UK but in some European countries there is little recognition of its value. An ambitious new initiative is attempting to raise the status of the specialty across Europe
It should be easy to make a case for specialist cancer nursing whichever European country you happen to be in. Internationally, a host of studies have made it clear that highly trained nurses have a positive impact on outcomes and on patient experience.
Yet this message is not getting across to policymakers, or at least not in a consistent way. Indeed, the situation of cancer nursing across Europe is patchy, with some countries recognising the vital role that nurses play in improving quality of care and outcomes for patients while others simply do not.
This is a situation that the European Oncology Nursing Society (EONS) is currently trying to address. Its RECaN (Recognising European Cancer Nurses) project aims to emphasise the key role of nursing in cancer care, improving recognition of the value of oncology nurses wherever they are working in Europe.
‘There are some countries, such as the UK and Sweden, where cancer nursing is well-advanced and well-developed,’ says EONS president Daniel Kelly. ‘Then there are others where it is less well-developed, perhaps because historically there hasn’t been a culture of extended nursing roles and autonomy.
Look at the evidence
‘The project is trying to establish the benefits of having well-qualified, well-trained and recognised cancer nurses. It’s looking at things like career progression for nurses and outcomes for patients. It’s not going to come up with all the answers, but it’s a real start.’
The project has its roots in last year’s congress of the European CanCer Organisation (ECCO), where the workforce – particularly the cancer nurse – was cited as a priority. EONS, a founding member of ECCO, has now embarked on a three-phase project aimed at emphasising nursing’s key role in cancer care.
The first phase, which is already under way, is a systematic literature review of evidence of the benefits that nursing brings to people with a cancer diagnosis.
Phase two will involve case studies in four countries where there are differing levels of recognition of cancer nursing.
Not bound by politics
The third phase will involve sharing the information across Europe, possibly via the European parliament, and events to raise awareness among politicians and healthcare providers across the continent.
The political landscape of Europe has changed since the project began, with the UK voting to leave the EU in June’s referendum. ‘This project was obviously planned before Brexit put a spanner in the works,’ says Professor Kelly, who is also RCN chair of nursing research at Cardiff University.
‘But our view is that EONS isn’t a political organisation, it’s a professional organisation. We don’t believe we should be bound by politics so we are pressing ahead.’
Indeed, not all EONS’ member countries are members of the EU and they include states on or beyond Europe’s geographical borders, such as Palestine and Turkey.
Value, impact, outcomes
The systematic literature review is being led by Mary Wells, co-chair of the EONS research working group and professor of cancer nursing research and practice at the University of Stirling. ‘The primary aim is to identify and appraise the evidence on the value and impact of cancer nursing on patient experience and outcomes,’ she says.
‘We’re in the process of searching ten databases for all randomised and non-randomised controlled trials that compare cancer nurse-led interventions with standard care or no intervention.’
Part of the review will involve mapping the available evidence to find out where there are gaps, for example which cancer groups are more researched than others, with a view to making recommendations about future research areas.
There is evidence that clinical nurse specialists make a difference to patient experience and outcomes in cancer, she says, citing cancer experience surveys in the UK that have consistently shown the value of specialist nursing.
Worth the struggle
‘Previous reviews of research have found that specialist nurse interventions are at least as successful as others, such as physician interventions, and some have shown improvements in quality of life. Our review is likely to endorse these findings,’ says Dr Wells.
She adds that one of the problems with research papers is often there is not enough detail about interventions themselves or their context, for example whether the care is given by general, specialist or advanced nurses, and their education level. ‘We’d like to see if different levels of nursing are associated with better outcomes or experiences.’
Professor Kelly would love to get to a point where there is a qualification in cancer nursing that is recognised across Europe. But he accepts this will take time.
‘In the UK we are struggling to get an advanced practice qualification recognised. Across Europe it’s a big ask,’ he says. ‘But it’s one that we think is worth it.’
Oncology training for nurses has been a part of life in Sweden since the 1980s, says Lena Sharp. But that doesn’t mean everything is fine.
'It’s not really recognised as it should be clinically. There are nurses working as cancer specialists, running out-patient clinics for example, but their role isn’t protected. If they left they could be replaced by a newly qualified nurse with no cancer training. That’s not the same as other specialties such as district nursing, midwifery or theatre nursing, where their competencies are recognised.’
Dr Sharp is head of cancer care improvement at the Regional Cancer Centre in Stockholm-Gotland in Sweden, and a senior researcher at the world-renowned Karolinska Institute.
She is also president-elect of EONS, and is faculty chair for the annual masterclass run by EONS for cancer nurses. ‘It’s fantastically interesting to discuss cancer nursing with a wonderful group of individuals from different places,’ she says.
‘In some countries there is no specialist training for cancer nurses – yet they are doing the same tasks (such as delivering chemotherapy) as we are.
‘There is a lot of evidence to show that better-trained nurses give better quality care for patients. If a pill or new drug had a similar effect they (employers) would jump on it, but the competencies of our staff are not recognised in the same way.’
She hopes the RECaN project will have a real impact on services across Europe. ‘If EONS can take this up as an issue with political stakeholders, if the EU could see the value of cancer nursing – that it’s cheaper, and safer than the way we organise cancer care today, then it might make a difference.’
Lemme-Liis Aruväli works in the department of radiotherapy and oncotherapy at Tartu University Hospital in Tartu, Estonia's second-largest city.
A registered nurse, her duties involve managing chemotherapy for inpatients, taking care of emergency patients with a cancer diagnosis, and monitoring radiotherapy inpatients.
‘Unfortunately, we don't have an education programme for cancer nurse specialists, so all the nurses who work with cancer patients are registered nurses or studying to become one,’ she says.
‘We definitely need a programme for cancer nurse specialists. I see in my everyday work that my patients don't get enough information about their illness, treatment plans, changes that could happen or need to happen in everyday life after diagnosis and so on.’
Ms Aruväli says patients are often scared when they first come to her department because of a lack of information, but the nurses’ workload gives them little time to explain everything.
‘We as nurses need a lot of more education and training in this specific field,’ she says.
‘It is inspiring to see that cancer nurses in our department want to make a change, because the need for nurse specialists is evident in our everyday work.
‘The cancer nurses in Estonia have come a long way in the past few years but still a lot has to be done to improve patient care.’
She is optimistic about the RECaN project. ‘It gives us hope,’ she says simply. ‘Hope to be heard and encouraged. Hope to get the support and knowledge. Hope to be able to make a change in our small country where cancer nurses' hearts fight with and for our patients.’
Patrick Jahn is head of nursing research at the University Hospital in Halle, Germany, and has a background in cancer nursing. He would like to see more formal recognition for the role of nurses in looking after patients with cancer in Germany.
‘In the clinical situation, patients with cancer depend on nurses to provide care including chemotherapy and patient education,’ he says. ‘In day-to-day practice, everything depends on nurses – but the recognition of this is not high.
‘Informally, patients appreciate what nurses do for them, but the process is very much physician-led. Nurses are not in charge, the physicians delegate to them. We are lacking that formal recognition.’
Dr Jahn believes Germany is some 15 years behind some other European countries in terms of extended roles of nursing. For example, nursing is still a diploma qualification in Germany, although there are moves to promote degree-level nurse education.
While there is no formal cancer nurse specialist qualification in Germany, there is a continuous education programme in cancer care. ‘This involves 720 hours of theoretical training over 2 years – and for that, the nurse gets an extra €100 per month. It’s not very much,’ he says.
Nurses working in cancer care are not required to take part in this programme, although it is expected that nurses working in specialist centres will do so. Dr Jahn says the German cancer nursing society recommends that only nurses with this extra training should be allowed to provide chemotherapy, but workforce pressures mean it is not possible to enforce.
He is hopeful that the EONS RECaN programme will be a useful first step in helping German cancer nursing to progress. ‘It is good to have nursing role models from other countries. It gives us a good overview of what is happening elsewhere and what is possible.’
Jennifer Trueland is a freelance health writer