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Opportunities in critical care oncology

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Despite the hi-tech environment, a passion for the latest medical machinery is not a prerequisite for a career in oncology critical care. Fundamental nursing skills such as good communication and empathy remain high on the list of essential attributes, according to Keetje Verdult, an F grade staff nurse in critical care at London’s Royal Marsden Hospital.

‘I took over the care of a woman who had undergone major surgery, and who hadn’t slept for a few days,’ recalls Ms Verdult, referring to an event during a busy night shift.

‘It was clear she desperately wanted to talk to me, but was having difficulty because her tracheostomy tube had been removed.

I stood close to her, and pressed on her throat dressing so she could speak. She told me she had some very difficult family problems on her mind. They were eating away at her, stopping her from getting the rest she needed. But after talking through the issues with me she was eventually able to fall asleep.

‘It would have been easy to sedate this patient, but that would not have got to the source of her problems,’ she says.

Ms Verdult realised she wanted to work with cancer patients while she was still a nursing student. ‘I just fell in love with oncology,’ she recalls.

Her first post after she qualified was at the breast care unit at Guy’s and St Thomas’s NHS Trust in London (now a foundation trust). She then switched to the Royal Marsden Hospital, where she enrolled on a one-year postgraduate course in oncology nursing. At that time the course required E grade entry, but D grades with at least six months of postregistration experience can now apply.

The course now, as then, offers a variety of different pathways such as women’s cancers, men’s cancers and surgical oncology, based on core components plus specialist modules and appropriate placements. Ms Verdult opted for care of the critically ill patient, which she felt would fill gaps in her training to date. ‘I was aware I lacked acute experience and I wanted to improve my skills in assessment and care of people who became acutely unwell,’ she says.

Her final placement on the course - in intensive care - proved to be a career-shaping experience. Two years later, and with the postgraduate intensive care course under her belt, she feels a strong commitment to oncology critical care.

The Royal Marsden critical care service has undergone a major reconfiguration since Ms Veerdult first joined its ranks in 2003. Both a six-bed CCU at the Chelsea site specialising in solid tumours and a three-bed leukaemia CCU at Sutton have been replaced by a brand-new 11-bed unit specialising in critical care for all cancer patients - complete with a new operating theatre and rapidly expanding surgical services.

It is the only specialist oncology CCU in the UK, although of course cancer patients are cared for on general CCUs at other centres. The Christie Hospital in Manchester is now moving in a similar direction, with the development of specialist critical care services.

Nurses like Ms Verdult who undergo dual training in cancer and critical care nursing cannot, as yet, apply both sets of skills at any other hospital. But experience at the Royal Marsden CCU leaves individuals well placed to take their knowledge and experience in either direction.

The expansion and centralisation of the unit reflects the increasing demands on oncology services. Advances in treatment, longer survival times and the care targets enshrined in the government’s Cancer Plan of 2000 have increased the pressures on many aspects of the broader specialty, with a knock-on effect for critical care.

The therapeutic advances also add to the job satisfactions inherent in what many observers wrongly believe is a depressing field of work.

‘When I say I’m an oncology nurse people assume it must be awful,’ admits Ms Verdult. ‘But it’s an absolute pleasure to work with cancer patients.

‘You can make such a difference. A cancer diagnosis has a huge impact on patients and their families. Even now, when there are far more effective treatments available, people automatically associate cancer with death. As a nurse there is so much you can do to offer information and support.’

As for the world of critical care, having stumbled upon it during her oncology training, Ms Verdult is a complete convert.

‘I love it. There is a definite buzz and it’s fast-paced. You really have to understand basic topics such as anatomy and physiology. And you have to use that knowledge to make decisions quickly.’

Colleagues outside her specialty often assume oncology critical care is synonymous with palliative care. She is quick to explain that the service offers far more than a hi-tech environment in which patients die.

‘We carry out major treatments here. We see patients who are incredibly unwell and we see them pull through - which is hugely rewarding.’

Even so, she acknowledges that cancer critical care has one deep-seated difference to the general CCU. ‘Once other desperately ill patients get through their crisis they tend to be on their homeward path. Our patients get better. But they still have their cancer to face.’

How do I become an oncology critical care nurse?

  • This could be for you if: you are interested in cancer nursing, intensive care and postoperative care.
  • You need to be good at: communication, teamworking and thinking on your feet.
  • You need to have: at least six months’ experience as a registered nurse.
  • You don’t need to have: previous training in oncology or critical care nursing.
  • Other similar jobs you could consider: oncology ward nursing.
  • Where to find more information: visit the www.royalmarsden.nhs.uk website for details of training and job opportunities.
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