Analysis

How a ‘passport’ can cut times on cancer nurse training and ease the transition between jobs

Cancer nursing could be moving towards a UK standard of practice, with nurse training being aligned to the same competency framework.
SACT Competency Passport

Cancer nursing could be moving towards a UK standard of practice, with nurses being trained in line with the same basic competency framework

The UK-wide standard of practice would mean cancer nurse specialists no longer need obligatory retraining when they move hospital and their hard-earned qualifications continue to be recognised.

Trusts in London have agreed to adopt the UK Oncology Nursing Societys (UKONS) Systemic Anti-Cancer Therapy (SACT) Competency Passport.

Clinical assessments

22.5 hours The average time taken to complete the passport theory section during the pilot scheme

The passport, piloted across eight organisations in London, comprises a workbook on SACT theory and clinical practice assessments, as well as annual reaccreditation.

It is a revised version of the All Wales Clinical Competencies for the Safe Handling and Administration of Cytotoxic Chemotherapy framework, implemented

...

Cancer nursing could be moving towards a UK standard of practice, with nurses being trained in line with the same basic competency framework


Picture: Barney Newman

The UK-wide standard of practice would mean cancer nurse specialists no longer need obligatory retraining when they move hospital and their hard-earned qualifications continue to be recognised.

Trusts in London have agreed to adopt the UK Oncology Nursing Society’s (UKONS) Systemic Anti-Cancer Therapy (SACT) Competency Passport.

Clinical assessments

22.5 hours
The average time taken to complete the passport theory section during the pilot scheme

The ‘passport’, piloted across eight organisations in London, comprises a workbook on SACT theory and clinical practice assessments, as well as annual reaccreditation.

It is a revised version of the All Wales Clinical Competencies for the Safe Handling and Administration of Cytotoxic Chemotherapy framework, implemented in 2015.

The Welsh version requires biennial reaccreditation.

Speaking at the launch of the SACT framework in London earlier this month, Royal Marsden NHS Foundation Trust chief nurse Eamonn Sullivan said: ‘I spent some time with some of our new starters and there was a real frustration that their hard-earned qualifications from other hospitals in London and beyond weren’t being recognised. That has to stop.’


Royal Marsden NHS Foundation
Trust chief nurse Eamonn Sullivan
Picture: Barney Newman

He said the document sent out ‘a powerful professional message', adding: ‘We will uphold rigorous, high-quality standards for our nurses to ensure safe practice, but actually we trust you as registrants as well to take this document and work right across London.’

With Wales having already accepted the standards and London trusts working towards them over the next six months, UKONS president Richard Henry is confident the framework will eventually be adopted UK-wide.

‘A document of this type shouldn’t be confined to London, this should be across the country. Indeed, one of the things we would like to see at UKONS is some sort of dissemination strategy.

‘After all, nurses don’t just move between London hospitals. They move to and from London, from other hospitals and from other countries. And I’m talking as someone from Ireland, which has supplied battalions of nurses to London.’

12
The number of sections the passport workbook contains, four of which are compulsory

He said the ‘high-quality document’ would gain support across the UK, once it had been established in London and proved successful.

Evidence and an effective dissemination strategy are likely to be key to a UK-wide framework ever being realised.

Skills across every specialism

UKONS developed the passport jointly with the Capital Nurse programme – set up in 2015 to boost the training and recruitment and retention of nurses in London – and is funded by Health Education England, NHS Improvement and NHS England. The aim is to eventually create a pan-London passport of skills for all nurses, across every specialism.

But, given this is one of Capital Nurse's first breakthroughs since its inception two years ago, an expansion of the SACT framework across England, let alone into other devolved territories, could be a lengthy process.

‘It is not always easy to get a consensus’

Rosie Roberts


Wales Cancer Network specialist
team member Rosie Roberts
Picture: Barney Newman

Wales Cancer Network specialist project team member and chemotherapy nurse Rosie Roberts explains: ‘Wales has got an advantage. Although it’s fairly big, there is a great deal of unity and there is a tradition of doing All Wales work.

'However, as we all know, it is not always easy to get a consensus, and different people wanted different things and felt precious about the tools they had devised over many years.’

She says there was huge variation in SACT training across Wales before the framework's introduction.

‘There was no agreed standard. Although there had been university accredited chemotherapy modules in Wales in the past, they had been withdrawn so the theoretical content that was being provided was locally based, and usually variable.

‘Consequently, when staff moved from hospital to hospital, they would be reassessed because nobody would trust what anybody else had done was the same standard.'


Capital Nurse lead Chris Caldwell
Picture: Barney Newman

Capital Nurse lead Chris Caldwell expressed confidence at the launch event that the passport model could be built on and replicated in other specialisms.

‘This is only the beginning,’ she said. ‘The fact we have done this in cancer is so important and is going to mean we can do it in a lot of other areas.’

For her, achieving a London-wide consensus on SACT standards is proof other specialties can agree on a set of principles.

Achievable

Perhaps it is also proof a UK-wide SACT framework is achievable – however long it takes. For those who put the framework together, such a development is important for patient care and the retention of nurses.

‘If I have cancer, I should know and be able to trust that any nurse – whether it is in Brixton or Barnet – has got the same skills and can deliver that care,’ said Ms Caldwell.

‘We know some nurses leave because they feel that they are giving drugs all day long. It’s a technical task and not what they came into nursing for’

Chris Caldwell

2018
The year in which the framework evaluation will be conducted 

Moreover, she said there has been a growing perception, from both patients and nurses themselves, that nurses have become ‘drug-pushers’, with only enough time for the technical side of care.

‘We know some nurses leave because they feel that they are giving drugs all day long. It’s a technical task and not what they came into nursing for.’

The SACT framework therefore aims to increase patient and nurse interaction, with nurses expected to pick up on negative reactions to treatment.

Job satisfaction

It is hoped that future SACT care will not only improve patient experience, but give nurses more job satisfaction.

100 nurses (at least)
are expected to be trained under the passport scheme over the next academic year

This, in turn, will save trusts money on training and recruitment.

‘If we can increase retention by just 1% we release so much cash,’ says Ms Caldwell, explaining this could run into the millions across London.

It is not just the cost of training and recruitment campaigns that worries trusts. Nurses new to a ward can face a month or longer on the sidelines, waiting to be signed off. This means a reliance on agency staff in the interim or wards being left short staffed.

‘The time normally spent training each nurse as they move will be additional time saved’

Kenye Karemo

The passport is therefore a welcome initiative for Barking, Havering and Redbridge University Hospitals NHS Trust deputy chief nurse Kenye Karemo.

‘The time normally spent training each nurse as they move will be additional time saved. It also manages risk as each trust has its own standards and way of doing things.’

‘If you look after your nurses, you can do it’


Catherine Oakley
Picture: Barney Newman

Catherine Oakley, chemotherapy nurse consultant at Guy’s and St Thomas’ NHS Foundation Trust and former UKONS president, led the work on the London framework.

In preparation for its implementation, with emphasis on better holistic care, her trust reassessed the length of time nurses spent with patients.

On average, the time each patient spent with a nurse increased by around 30 minutes.

‘We are expecting nurses to have additional skills in terms of supporting patients, picking up on psychological changes and reactions,’ she explains.

‘If we’re expecting them to do that, we have to schedule the time to do that. It’s no good if they can’t talk, just push drugs in.’

The additional time has been found by shortening appointments that used to be longer than they needed to be, and rostering in more nurses.

This has been made possible by better retention.

‘If you look after your nurses you can do it,’ says Dr Oakley.

‘I know how many patients each nurse treats. If we expect ten to 15 patients, we aren’t going to retain nurses – they are going to burn out. If they treat six to eight, and get breaks, and we look after them right, we are going to retain them.’

A year in and the changes have resulted in better retention and fewer nurses feeling burned out, she says.

'Burning out is not good for nurses and it is not cost-effective because we do invest a lot in training people.'

The framework will be rolled out across London over the next six months and incorporated into local training programmes, including those run by universities.

Pilot sites

  • Barts Health NHS Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Imperial College Healthcare NHS Trust
  • King’s College Hospital NHS Foundation Trust
  • The Royal Marsden NHS Foundation Trust
  • University College London Hospitals NHS Foundation Trust
  • London North West Healthcare NHS Trust
  • Lewisham and Greenwich NHS Trust

 

 

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