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'The tensions around specialist nursing cannot be ignored'


This week sees three contrasting reports on the role of specialist nurses in the NHS.

On Monday Diabetes UK published research showing 218 diabetes specialist nurse posts were left vacant by trusts in 2010 due to cost cutting reasons. The charity used the study to highlight the valuable role DSNs play in preventing sight loss and limb amputation.

The annual National Lung Cancer Audit, also published on Monday, said patients who saw a specialist cancer nurse were more than twice as likely as other patients to receive treatment for lung cancer. 

Meanwhile, the third ever IBD Audit, published on Tuesday, celebrated a 10% increase in the number of hospitals with access to inflammatory bowel disease over the past three years – marking a new high of 72%.

These three reports follow figures published by Nursing Times in March showing the number of outpatients treated by specialist nurses is rising by more than 100,000 a year. Commentators described it as “powerful evidence” of the growing role of specialist nurses in the NHS.

However, this can be a tricky topic. While the role of specialists is often talked up in reports such as those published this week, it cannot be ignored that there are tensions surrounding their role.

Regular stories over the last five years about specialists being redeployed by trusts to fill staffing gaps on wards are perhaps unlikely to curry much favour with the rest of the nursing workforce. While it is undoubtedly a waste of resource for specialists to be filling non specialist roles, there is a risk of them being seen as “too special” to get their hands dirty.

On the other side of the fence, they are still seen by some doctors as inferior invaders in their domain, rather than a valued member of the multi-disciplinary team.

Then of course there is the hard-to-shake tag that “anyone can call themselves a specialist nurse”, due to the continued lack of regulation for advanced practice and legally protected titles.

But the very fact it is the specialists that have been mentioned in three reports this week demonstrates the important role they have as flag bearers for modern nursing.

Against a background of cuts, cuts and more cuts, the attention specialists receive may not be universally welcomed.

But, as they are often one of the first affected, as highlighted by charity PR muscle, their loss or misuse should act as a litmus paper for more widespread workforce challenges facing the nursing workforce.

Specialist nurses are at the forefront of helping to inform the public about how the profession has moved on from the Carry On caricature.  They and their work must be supported and championed. 


Readers' comments (6)

  • 'inferior invaders' o my! ;)

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  • Always hated these so-called specialist cherry picking roles creating fragmentation of patient care

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  • I am an MS nurse (not an elite 'specialist'), that's it!! I look after MS patients, anyone can do it, given the training!
    I am not too special to get my hands dirty and only left the wards to seek promotion where none was available, which saddens me as I wanted to move through the ranks on the ward as they are the special ones, doing the hard work, long hours and christmas days
    That said we do see lots of patients that would otherwise be bothering their ill-informed GP's, utilising hospital services and possible admission to hospital and i think in that respect we are valuable, but not special!

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  • 1. Please review my comments in response to Jenni's article 5/29 re UK vs US.
    2. In reference to the comments on Steve's article covering tensions - I would point out that, contrary to opinion, not "everyone can do it" well; trained or otherwise. During my career, I have witnessed multiple appalling errors made in patient interventions and on a daily basis.
    Have concrete examples to share if anyone cares.
    3. We have also become a "multi-task" profession in that we spend a significant amount of time documenting and reviewing records on inappropriate software programs which are ill conceived and are actually also dangerous when dealing with lab values etc. (again have multiple examples). The old system of a clip board and chart for each pt. was by far much faster, available, and more accurate without the additional cost of an army of highly paid IT staff who invariably treat nurses as if they were working for them versus the facility/pts. The systems fail frequently.....paper notes do not. I am proficient, computer literate and speedy, but do not believe that computer interfacing belongs in nursing. Cleaning duties, garbage removal and other tasks unrelated to nursing are thrown in while we care for the patients. One e.g. Have corporate tried to initiate a blood transfusion while being mandated by the desk to clean up fresh vomit from the floor at the next bed? (I had requested housekeeping) All about the dollar! as noted to the editor.
    It's not a question of "not wanting to
    get hands dirty". It's common sense and infection control.
    4. Don't even get me started on staffing levels and hours.

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  • Specialist cherry picking roles fragmenting care? Hmm, my experience is of specialists plugging flailing gaps in provision where people all too often fall down ending in injury, admission or worse, let alone feeling isolated and scared with a great heavy label of diagnosis to take home from hospital.
    Not all staff are able to 'do' specialist care because if they were then the roles would not be required.
    Of course some people will be snooty about the roles but from what I see no particular group has a monopoly on that one.
    Personally I support the roles, if you hadn't guessed. Whether people feel the attraction to take up a role is horses for courses but that is different from their value or the need for them

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  • I am a Specialist Nurse and have completed a Masters degree in my speciality as well as a PG Cert in CBT and Prescribe as an independant practitioner. I currently see 80% of all new patients referred to our service ( majority of these do not see a medical consultant) providing a comprehensive service. Due to a high demand of referrals to our service I regularly work many hours over my 37.5 contracted hours as do many other specialist nurses I know. I do think that the term 'specialist nurse' is over utilised within the nursing profession and that there should be more robust guidelines for this role. I am always happy to give advice to ward staff however, in reality I have very little time to do this. We are much cheaper than Consultant medical staff and generally patients do prefer talking to a nurse rather than a doctor.

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