Analysis

Cancer nurses do compulsory training in their own time, our survey shows

Many nurses are using holidays for continuing professional development work and paying for it themselves, according to a survey by Cancer Nursing Practice
Picture shows a woman studying. Many nurses are using holidays to do continuing professional development and paying for it themselves, according to a survey by Cancer Nursing Practice.

Many nurses are using holidays for continuing professional development work and paying for it themselves, according to a survey by Cancer Nursing Practice

  • Cancer nurses struggle with continuing professional development (CPD) due to lack of time, funding and resources
  • Staff shortages, stretched budgets and patient demand knock CPD off workplace agenda
  • Nurses advised to use annual appraisal to set out their CPD plans and obtain support

More than two thirds of cancer nurses have been forced to carry out essential training and education in their own time, a Cancer Nursing Practice survey suggests.

Almost one third of the 187 respondents had used annual leave to carry out continuing professional development (CPD) and paid for courses out of their own pockets.

More than one in five nurses who responded to our survey said they usually or

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Many nurses are using holidays for continuing professional development work and paying for it themselves, according to a survey by Cancer Nursing Practice

  • Cancer nurses struggle with continuing professional development (CPD) due to lack of time, funding and resources
  • Staff shortages, stretched budgets and patient demand knock CPD off workplace agenda
  • Nurses advised to use annual appraisal to set out their CPD plans and obtain support
Picture shows older woman studying. Many nurses are using holidays to do continuing professional development and paying for it themselves, according to a survey by Cancer Nursing Practice.
Picture: iStock

More than two thirds of cancer nurses have been forced to carry out essential training and education in their own time, a Cancer Nursing Practice survey suggests.

Almost one third of the 187 respondents had used annual leave to carry out continuing professional development (CPD) and paid for courses out of their own pockets.

More than one in five nurses who responded to our survey said they ‘usually’ or ‘never’ had enough time for CPD.

Overstretched nurses struggle with workload and lack time to carry out CPD

All nurses must carry out at least 35 hours of CPD every three years to revalidate and maintain their nursing registration.

Asked what the main barriers were, responses suggested overstretched nurses are struggling with their day-to-day workload and have too little time to carry out CPD.

What continuing professional development entails

According to the Nursing and Midwifery Council (NMC), nurses must undertake 35 hours of continuing professional development (CPD) relevant to their scope of practice in a three-year period since their registration was last renewed or when they joined the register.

Of those 35 hours of CPD, at least 20 must have included participatory learning (activity that involves interaction with one or more other professionals, such as attending a conference, workshop or relevant training course).

Nurses must also keep a record of CPD undertaken, which must:

  • State the CPD method
  • Describe the topic and how it relates to practice
  • Give the dates on which the activity was undertaken
  • List the number of hours (including the number of participatory hours)
  • Identify the part of the NMC code of conduct most relevant to the activity
  • Provide evidence that they undertook the activity

(Source: NMC – Revalidation/What You Need To Do: Continuing Professional Development)

More than half of respondents said lack of time was the main barrier, followed by lack of funding and lack of resources.

Read Cancer Nursing Practice peer-reviewed CPD articles

Nikki Cannon, who is transformation lead for cancer survivorship at Guy's and St Thomas'​ NHS Foundation Trust and a former Macmillan Cancer Support specialist adviser for workforce engagement, says access to CPD is ‘critically important’ for cancer nurses and essential for patient safety.

More people are being diagnosed with cancer and living longer with it and with the long-term effects of treatment.

By 2030, 4 million people will be living with a cancer diagnosis in England, according to Macmillan.

Immunotherapy is great hope for cancer patients, but it has side effects

Treatments are increasingly complex, and staff need the skills to support their patients in navigating the care and support pathway.

Ms Cannon says: ‘Nursing is a safety-critical profession, especially if you are talking about cancer nursing, where the majority of care is quite complex – and becoming more complex – and it requires staff to keep up to date.

‘Immunotherapy is the great hope for cancer patients, but it doesn’t come without side effects. It is so important that patients be informed and understand.’

4 million

people will be living with cancer in England in 2030 according to Macmillan Cancer Support

The proportion of staff reporting having to use their own time to carry out CPD is concerning, she says. The survey found that many nurses are coming into work early, staying late or using their holiday time to access the training they need.

Only one in five respondents said they have enough time to do CPD.

Carrying out CPD on their own time ‘is on top of staff regularly having to work extra hours,’ Ms Cannon says.

‘Just finding the time to be released to study is becoming harder and finding the funding is becoming harder’

Nikki Cannon, transformation lead for cancer survivorship

‘There is a perfect storm of circumstances blocking nurses from accessing the CPD they need. There is a crisis in cancer nursing, and just finding the time to be released to study is becoming harder and finding the funding is becoming harder,’ she says.

Five learning principles for health and social care

The RCN joined other professional bodies and health unions  in 2019 to launch a set of CPD and lifelong learning principles for health and social care. These state that CPD and lifelong learning should:

  • Be each person’s responsibility and be made possible and supported by employers
  • Benefit service users
  • Improve the quality of service delivery
  • Be balanced and relevant to each person’s area of practice or employment
  • Be recorded and show the effect on each person’s area of practice

(Source: RCN 2019)

The problems are highlighted in a Macmillan report, Voices from the frontline, on challenges facing cancer clinical nurse specialists.

The 2019 Macmillan study, involving 270 cancer clinical nurse specialists in England and interviews with 16 lead cancer nurses, also pointed to a lack of protected time, funding and locally available courses.

Picture shows a ward training session on the use of IV drips. Many nurses are using holidays to do continuing professional development and paying for it themselves, according to a survey by Cancer Nursing Practice.
Picture: iStock

‘Without backfill for clinical commitments, many nurses are unable or unwilling to undertake CPD,’ the report says.

‘Time and again we heard of the catch-22 whereby cancer services seeking to fill specialist adult cancer nursing posts are struggling to find nurses with the right experience to do the job, while general adult nurses are unable to obtain the funding or time to gain specialist skills they need to secure a specialist role.’

‘Education will always be pushed back and will become less of a priority when you’ve got a ward that you can’t staff effectively’

Survey response by a Macmillan lead cancer nurse

The struggle for funding is highlighted in the report. It shows nurses having to apply for funding in a piecemeal manner, module by module, slowing down their progress, and money being diverted away from clinical nurse specialist (CNS) posts to advanced nurse practitioner (ANP) courses. The inequity of nurses having to self-fund is also flagged up.

A lead cancer nurse told the survey: ‘People often fund their own education, and that’s difficult. Not everyone can. There are many people who are the only breadwinner or not in a position to spend. It’s quite discriminatory.’

£1,000

budget for each NHS registered nurse in England towards revalidation costs over three years.

In another response, a Macmillan lead cancer nurse said: ‘Education will always be pushed back and will become less of a priority when you’ve got a ward that you can’t staff effectively. We just haven’t got a nursing workforce at the moment to allow people to get the education that is needed.’

An RCN member briefing on CPD published in December 2019 described how funding budgets across nursing have been cut in recent years.

The document stressed that CPD is a basic professional requirement and is in addition to any mandatory or statutory training that employers provide.

The UK government contribution to CPD in England is funded through Health Education England (HEE).

This budget for registered nurses has been reduced significantly in recent years, falling from £205 million in 2015-16 to £83.5 million in 2018-19, the RCN says.

‘Failing to invest in CPD does not make sense for employers’

‘Staff shortages, stretched budgets and increasing patient and client demand mean that professional development too often falls off the workplace agenda,’ it says.

In September 2019 the government announced a £1,000 budget for each registered nurse working in the NHS in England to contribute towards revalidation requirements over three years.

But it is not yet clear how funding will be allocated to staff working in non-NHS, publicly funded health and care services.

Case study: trust runs model cancer school

The Royal Marsden NHS Foundation Trust shows its commitment to education by running its own school. The Royal Marsden School was originally set up to provide cancer education for nurses at the trust. Its students now include nurses, allied health professionals, volunteers and healthcare support workers from across the NHS and many other organisations.

School director and cancer nurse Rebecca Verity says students are taught by clinical specialists and research experts working at the leading edge of cancer care. Patients are also involved in training, giving students a unique perspective on treatment. ‘We recognise that people working in a specialist centre need specialist knowledge,’ says Dr Verity.

‘I feel privileged to work here, it is unique and very specialist,’ she says. ‘We are an academic department within an NHS trust. We offer about 26 modules and we run at degree and master’s level. Modules range from enhancing clinical leadership in cancer practice to more specialist areas and research modules.’

The trust is ‘100% committed to education’ and very supportive of staff access to CPD, she says. ‘It is one way we attract staff – our study leave is excellent,’ Dr Verity adds.

As the school is part of the trust, education is ‘grounded in practice’ and it can respond rapidly when education gaps are spotted, she says. ‘If there is a problem we can respond to it quickly. I believe in this model. All of the education we give is relevant to clinical practice.’

She says she needs to gather more proof on the difference good CPD can make. ‘One of the challenges in my role is to get more robust evidence to demonstrate the impact of education and supporting staff, and to demonstrate how practice is improved by education.’

Only 24% of the cancer nurses responding to the Cancer Nursing Practice survey said there were no barriers to accessing CPD.

Queen’s University Belfast senior lecturer in cancer and palliative care Barry Quinn says failing to invest in CPD does not make sense for employers at a time when the nursing shortage means nurses can simply seek out jobs that will support their development.

Picture of Queen’s University Belfast senior lecturer in cancer and palliative care Barry Quinn. Many nurses are using holidays to do continuing professional development and paying for it themselves, according to a survey by Cancer Nursing Practice.
Barry Quinn Picture: David Gee

‘It is pure madness for nurses not to be receiving CPD,’ he says. ‘Engaging with staff through CPD is a way of retaining and maintaining good staff and skill mix.’

Well thought-out and clearly argued funding proposals

But nurses and their managers also need to take responsibility for CPD, seeing what courses or opportunities are available, what will fit in with their personal and professional lives, and how this will benefit their service, says Dr Quinn.

He says that when working as the director of nursing for cancer at a large London NHS trust he never struggled to obtain approval for well-thought-out and clearly argued funding proposals for staff training.

Too often nurses are not saying what they need and making a good business case, he says.

‘CPD should be a core part of every appraisal, and there should be a clear professional plan. That is the responsibility of the nurse, to present what they want to do over the next 12 months for themselves and the service. Their manager needs to be trained to analyse and support the nurse in that CPD,’ says Dr Quinn.

35 hours

Amount of time all nurses must devote to CPD every three years to remain on the NMC register.

Nurses should think more creatively about where CPD comes from, looking at partnerships with pharmaceutical companies and universities. Many cancer charities also offer a range of courses for nurses.

Clinical nurse specialist roles are important link for patients

Too often in cancer care nurses can be put into positions they are not ready for, Dr Quinn says. This is often seen in CNS roles, which are an important link for patients on their cancer journey. But too much of the funding that should be going to the CNS is being diverted to ANP roles, he says.

‘A good example is the cancer nurse specialist. You need to be at the top of your game for this role, but how have the nurses prepared themselves and how has the manager or service prepared them?

‘The specialist nurse is a key worker who journeys with the patient. CPD is not just about clinical skills, but also critical skills, really thinking about what is your role as a nurse.’

CNP infographic

Find out more


Erin Dean is a health writer

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