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Becoming a Macmillan specialist nurse

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Hayley Pover on making the transition from ward sister to Macmillan clinical nurse specialist (CNS)

After qualifying as a nurse in 2007, I worked in Accident and Emergency for one year before moving to a Medical High Dependency Unit, where I became a ward sister. I was then seconded to a Breast Care Unit. This was a role I really felt inspired by.

I have had a keen interest and passion for helping people with breast cancer from a young age, since my mum developed breast cancer when she was 39. She had a mastectomy and was well for several years, but she then developed a recurrence. She passed away peacefully when I was 20 years old.

I applied for the permanent role and became Macmillan Breast Cancer Specialist Nurse in August 2014.

Adapting to the new role

Making the transition from ward nurse to CNS was more challenging than I expected. Being an independent practitioner felt isolating at times and there was a higher degree of responsibility.

One area I found difficult was counselling people I was caring for. When people opened up and expressed their deepest concerns, I found it challenging to explore these further. I wanted to come up with solutions; I didn’t want to upset them further, so this resulted in me missing opportunities to help.

When I watched my experienced colleagues, it appeared so easy and natural to them and the patients appeared settled, comforted and supported. It was inspiring watching them and seeing how people benefited from their support throughout their diagnosis and follow-up. I was determined to develop my abilities and become that kind of CNS.

Developing new skills

My colleagues have supported me through one-to-ones, talking through difficult situations, allowing me to shadow them, and giving me study time to attend courses. In less than one year, I have attended courses on advanced communications skills, and the principles and practice of breast care. These really helped me to start to understand how I should communicate effectively with people with cancer and carers, to address their concerns and support them through this difficult time.

The courses enabled me to develop my empathy and listening skills. They taught me the theory and practical actions required for effective communication and allowed me to practise these techniques in a safe environment. I was able to watch myself back on a video recording, which developed my self-awareness.

The courses have given me confidence and helped me establish areas for further development, such as identifying patient cues – where people indicate that they have more to say on a particular topic, if someone can encourage them to do so. It has been well documented that health professionals can either miss cues or block them.1 Health professionals may block patient cues because they feel inexperienced to deal with the concern or they have a lack of time to explore it further.2

Attending and interacting in multi-disciplinary team (MDT) meetings enabled me to gain insight into treatment decisions, how they may affect a person with cancer, and how I can support them with their decision. Attending these meetings also helped me network and arrange times to shadow each member of the MDT. This gave me a better understanding of the patient’s journey and afterwards I felt prepared to support them through each stage. I recently started having clinical supervision with our clinical psychologist, either as one-to-one or group sessions, which I feel has benefited me greatly; I can see that my own anxieties are perfectly normal. These sessions allow my colleagues and I to learn from each other, by acknowledging what we have done well, but also what we might do differently in the future. Clinical supervision was introduced to help health professionals reflect on practice, develop self-awareness, and improve the service they deliver.3

Clinical pressures are increasing, but as CNSs we must not neglect all the key elements of our role, which the Royal College of Nursing describes as clinical activity (on average taking up 60% of time), education (17%), management activity (14%), research (4%) and other duties (5%).4 I have learned to plan and organise each week to enable me to balance the time I spend on all the key elements of my role.

Looking forward

I will soon have been in post for one year, during which I have learned a great deal about myself and how I should be supporting people with cancer. In reflection, I can see how much I have developed. Every day is about learning and growing as a professional – we never stop. I now need to continue consolidating my learning, practise my new skills and use my new knowledge to become the inspiring and highly competent CNS I see in my colleagues.


1. Faulkner A, Maguire P. Talking to Cancer Patients and their Relatives. 2002. Oxford University Press. Oxford.

2. Burk CC. Psychosocial Dimensions of Oncology Nursing Care. Second Edition. 2009. Oncology Nursing Society. United States.

3. Royal College of Nursing. Clinical Supervision in the Work Place: Guidance for occupational health nurses. 2002. London.

4. Royal College of Nursing. Specialist Nursing in the UK. 2013. London

Further information

Hayley Pover

(pictured above)

Macmillan Breast Care Specialist Nurse

Salford Royal NHS Foundation Trust

0161 206 1173

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