Analysis

New framework sets out expectations for all levels of cancer nursing practice

For the first time, a comprehensive vision has been produced for what cancer nursing should look like at all levels – from student through to nurse consultant.
New framework for nursing practice

For the first time, a comprehensive vision has been produced for what cancer nursing should look like at all levels from student through to nurse consultant.

The Career and Education Framework for Cancer Nursing sets out a list of skills, competencies and knowledge expected at seven different levels of practice. It is the culmination of detailed and collaborative working between leading cancer nurses, who say it breaks new ground for the profession.

The framework draws on information from sources such as the European Oncology Nursing Society Cancer Nursing Curriculum and the Skills for Health Career Framework, as well as the experience of experts working in universities, hospitals and for charities in all four corners of the UK.

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Levels of practice applicable to the new framework

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For the first time, a comprehensive vision has been produced for what cancer nursing should look like at all levels – from student through to nurse consultant.

The Career and Education Framework for Cancer Nursing sets out a list of skills, competencies and knowledge expected at seven different levels of practice. It is the culmination of detailed and collaborative working between leading cancer nurses, who say it breaks new ground for the profession.

New framework for nursing practice
The education framework should enable cancer nurses to map out their careers. Picture: iStock

The framework draws on information from sources such as the European Oncology Nursing Society Cancer Nursing Curriculum and the Skills for Health Career Framework, as well as the experience of experts working in universities, hospitals and for charities in all four corners of the UK.

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Levels of practice applicable to the new framework

It has led to the steering group – supported by the RCN, UK Oncology Nursing Society (UKONS) and Higher Education Academy – producing a breakdown of what is expected for:

  • Pre-registration nursing students.
  • Support workers.
  • General/non-specialist nurses.
  • Specialist nurses at a registered level.
  • Specialist nurses at a senior level.
  • Specialist nurses at an advanced level.
  • Specialist nurses at a consultant level.

For each level of practice, it sets the requirements across eight different metrics including treatment, research and leadership in community and hospital settings.

The framework’s steering group hopes this will allow those starting out in nursing or just becoming involved in cancer care to map out their careers in a way that could never be done before.

But the group – led by the University of York's Professor Vanessa Taylor – also believes it will prove invaluable to specialist cancer nurses too.

Planting aspirations

Specialist nursing is split into four categories – registered, senior, advanced, and consultant.

Professor Taylor says: ‘We’ve not had anything like this before. Nurses can use the framework to make the case for training, education and professional development to achieve their career aspirations.’

She even hopes nurses will find it useful in arguing for more pay. It does not make suggestions for what banding each category of specialist nurse should be on as Professor Taylor says this is something that is ‘normally locally determined’.

But she adds that nurses can still use it to ‘demonstrate the level they are practising at or aspire to’ in discussions about banding and pay.

Redefining roles

Professor Taylor also believes the NHS should use it to redefine how specialist cancer nurses are referred to, calling for the term clinical nurse specialist (CNS) to be dropped in favour of one of the four categories used in the framework.

‘The CNS title can be ill defined in terms of the aspects of the role undertaken and the level of knowledge, skills and competence it represents.

‘We have CNSs working at very different levels of practice and graded on a range of bands – 6, 7 and 8.’

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Different metrics the framework's skills and competencies cover

She believes the terms registered, senior, advanced and consultant specialist would, instead, ‘improve clarity’ for the NHS and patients.

But the framework has not just been developed with nurses in mind. It sets out clear recommendations for how it wants managers, educators and commissioners to use it. It says employers and managers should use it to plan professional development for nurses, review services and design job descriptions when they need to recruit.

Higher education institutions can use it to ensure their pre-registration nursing curriculum covers what is needed for the basics of cancer care, as well as reviewing how their post-registration courses support nurses. The framework includes an audit tool to help them do this.

For commissioners, the framework should prove useful for defining what workforce they need in different settings and regions, and to help them determine what resources need investment to help workforce developments.

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Different levels of specialist practice

Nurse consultant Maria Noblet, who is past chair of the RCN cancer and breast care forum – one of the groups involved in developing the framework, says it is ‘important’ they all take notice.

‘What is in there is what senior nurses have been saying for some time,’ she says.

She believes the framework fills the ‘chasm’ that existed in terms of clearly defining how cancer nursing should look.

‘Years ago the RCN produced a framework that merged education and management of cancer nurses. But that is well out of date now so it really was time to do something.’

Already there are encouraging signs it will have an effect. Health Education England has confirmed it will be ‘looking’ at the framework as part of its review into the cancer workforce.

UKONS president Richard Henry says this is pleasing, but he wants more. ‘We needed something like this. The cancer workforce is changing and what we need to do now as a profession is go to the national bodies and governments across the UK and use this to help us make the case for investment in the cancer workforce.’

What skills and knowledge specialist nurses require

Registered, senior, advanced and consultant-level

  • Able to explain causes of cancer to patients and families.
  • Assess side effects of treatment.
  • Demonstrate knowledge about safe administration of cancer treatments and nursing interventions.
  • Work in partnership with a patient to manage symptoms and consequences of treatment.
  • Provide personalised care plans.
  • Assess whether and to what extent patients and their families will be able to self-manage their condition during rehabilitation.

Senior, advanced and consultant

  • Demonstrate a range of advanced communication skills to promote the well-being of patients, including the ability to counsel and challenge behaviour.
  • Provide leadership in the implementation and evaluation of cancer quality standards.
  • Actively promote the learning of others.
  • Demonstrate the ability to plan, allocate, coordinate and evaluate the use of resources when dealing with patients and their families.
  • Able to participate in clinical trials as part of a multiprofessional team and support junior colleagues in this role.

Advanced and consultant

  • Play a part in the development and delivery of cancer education.
  • Use specialist knowledge to contribute to the development of evidence-based policies and procedures.

Consultant only

  • Inform strategic direction and lead changes to cancer services.
  • Use knowledge of the research and audit process to develop and lead project.

Source: Career and Education Framework for Cancer Nursing 

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