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Blog: Are continence specialists worth it?

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Frank Booth is a firm believer that continence specialists nurses deliver great value, but can they prove it?

Sadly a great many continence clinical nurse specialists (CNS) are employed at Agenda for Change (AfC) Band 6 which may not fully reflect the value of what they do.

There are a number of CNS’s that operate at AfC Band 7 and also as clinical and management skills are developed we see the higher levels of nurse consultant and clinical service managers at AfC Band 8a and 8b.

But the question is: are we really worth it?

I was one of those continence clinical service managers and I have no doubt that CNS’s whatever their grade, are worth every penny and more, but can we prove it?

I can’t give you the individual evidence to help you justify the job you do, but I can help you to find it before your trusts decides that they cannot afford you.

We are interested in continence nurse specialist here but it shouldn’t matter what your speciality is, and clinical nurse specialists must look to other disciplines for wider support.

A CNS is a clearly defined role, regardless of the specialty you work in. You will have the basic knowledge of your chosen area, have undertaken additional theoretical or practical training with or without certification. If you are not sure then look at what AfC requirements for CNS, advanced practitioner or professional services manager or what appears in your or other CNS’s Knowledge and Skills Framework (KSF) for your grade.

Although AfC sets out the levels that you should attain we know that there was a great deal of inconsistency both within and between trusts. If we got this wrong for our CNS’s, how easy would it be to get your KSF wrong. Its worth looking again at the AFC and KSF documents.

When you’ve done this, does it remind you why you believe that you are working at the level of a CNS or advanced practitioner?

Assuming your manager accepts that you are a CNS, can they justify your role with evidence to more senior managers, human resources or the trust’s board? Don’t forget that you are an expensive commodity and will always have to justify your salary.

We know that continence care, involving promotion and management delivered at an expert level reduces costs and improves care. Can we prove this?

You need to look no further for proof than Good practice in continence services (2000) and the Paediatric continence examplar (2007). The exemplar is for children but it’s not rocket science to take this and with little effort turn it into an adult one – instant best practice!

The Right Honourable Patricia Hewitt MP, the then Secretary of State for Health, in a speech last year to the NHS Alliance Spring Conference said;

‘…instead of being sent to urology, patients are sent to a community continence service.’

Should we take from this that the evidence is clear now to government? That the community CNS for continence can be more cost effective than referral to a secondary care consultant in the first place? That integrated continence services are the right way forward and by following best practice we might actually get value for money as well as best patient care?

Perhaps you need to forgive my memory but didn’t the Department of Health say that in Good Practice in Continence Services document in 2000?

Of course for some of our colleagues, continence will be in secondary care, unfortunately the numbers game shows that these are few and far between. Is your secondary care trust inspired to have such support? If yes then true integrated continence services are just a short breath away if we can learn to work with each other. And why not?

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