It was the only job Valerie Nursey wanted to do. For 40 years she worked as a nurse in Surrey in the community and in general practice. 'I loved helping and looking after people,' she says.
When she retired in 2002 aged 60, she felt 'reasonably fit and healthy' and was looking forward to spending more time with her husband and two daughters. Just four years later, she was told she had mesothelioma - a rare and virulent form of cancer usually caused by breathing in asbestos particles. The disease has an average latency period of 40 years and sufferers have an average life expectancy of 18 months. As yet, there is no cure.
Ms Nursey 'knew nothing about the disease', and could only assume she had been exposed to asbestos while doing her nurse training in the 1960s at a Victorian hospital in the south of England.
'It comes as a big shock to find out the buildings or hospitals where you've looked after people, which are supposed to be caring environments, have probably given you this disease,' she says.
Her assumption about where she contracted her condition has never been proved. However, she is convinced 'there are more nurses out there like me'.
Nurses like Mary Artherton, who was diagnosed with the condition at just 58. She believes she contracted the disease as a result of being exposed to asbestos dust during her 40-year career working in Norfolk's city hospitals. Ms Artherton has since received compensation from The East of England Strategic Health Authority.
And nurses like Diane Coote, who worked at the same hospitals as Ms Artherton and was diagnosed with mesothelioma just before her 57th birthday. The East of England Strategic Health Authority settled on a figure for compensation in November 2008.
These cases have much in common, such as the ages at which the nurses were exposed to asbestos and at which they were diagnosed with the disease. All these nurses have to live with a terminal condition and they have been brave enough to speak publicly about the devastating effects of mesothelioma.
David Cass is a solicitor with Irwin Mitchell in Sheffield, a leading law firm which specialises in compensation for asbestos victims. It represented both Ms Artherton and Ms Coote.
He says in recent years the firm is increasingly representing not only skilled labourers and tradesmen, who cut through asbestos and installed lagging, but also people who have been exposed in much less obvious places, such as nurses working in hospitals.
'The experience of Mary and Diane reflects the vast majority of my nurse clients who are often reaching retirement, who, ironically, have worked hard all their lives to keep people healthy and who are then given this terrible diagnosis,' he says.
Anecdotally, Nursing Times understands there are other nurses too ill to speak out about the devastating effects of a condition contracted while caring for others, and more still who could develop the disease.
As yet the scale of the problem within nursing is unknown. The most recent figures from the Health and Safety Executive indicate a rising number of nurses are among the 4,000 people a year dying from the effects of asbestos. The number of nurses' deaths increased from 49 between 1980 and 2000 to 25 in the four years between 2002 and 2005.
However, the HSE states that there is no evidence to suggest nurses are at an increased risk of asbestos-related disease compared with that of the general population.
Kim Sunley, senior employment relations adviser for the RCN and health and safety policy lead for members, says: 'Compared with those working directly with asbestos, the risk for nurses is lower - but that's still a risk too many.'
That risk could result from exposure to asbestos in any public or commercial building built or refurbished before 2000.
The HSE estimates that up to 500,000 commercial, industrial and public buildings built before this time are likely to contain asbestos in some form. During 2008 it ran a campaign calling on people working in the building trade to take extra care to ensure they are not exposed to the lethal substance.
Unison estimates the scale of the problem is much larger - that 1.5 million buildings have asbestos.
Ms Sunley says nurses who have developed mesothelioma could have been exposed to asbestos while walking through underground passageways in hospitals where pipes and insulation panels lagged with the material were not properly maintained.
While the dangers of asbestos are well documented, the government has yet to take responsibility for removing it from hospitals, although in 2012 there are plans to make parliament asbestos free.
Commenting on measures in place to safeguard healthcare workers from the dangers of asbestos, a Department of Health spokesperson states each local NHS organisation as 'dutyholder' is required under health and safety legislation to assess the risk to staff and patients from any asbestos within their buildings. The organisation should then take action as appropriate to manage such risks.
According to the HSE, providing the asbestos is sealed and well maintained, nurses will not be at risk during their normal activities.
However, unions and mesothelioma support groups do not believe these measures go far enough - they want a national database so that employees and the public can check how much asbestos their workplaces contain. The Asbestos Testing and Consultancy Association (ATAC) would also like the government to establish a central register of all asbestos in public buildings.
Campaigners also want to see more research into finding an effective treatment for the condition. Gail Adams, Unison's head of nursing, says: 'We need much more investment in searching for a cure and for new ways of relieving what is a devastating disease.'
Support is available for nurses and their families having to deal with the disease. Mavis Robinson, a retired lung cancer specialist nurse and an adviser for the Ridings Asbestos Support & Awareness Group (RASAG), first came across cases of mesothelioma in the 1980s. The lack of information and support prompted her to set up the first mesothelioma phone helpline and to produce patient information on the condition.
Ms Robinson says she has supported a number of nurses with 'this damned disease' over the years. She says some of these nurses have not wanted to take a local hospital to task for possible exposure to asbestos 'in case that hospital might not want to treat them'.
Nurse consultant in mesothelioma Liz Darlison set up Mesothelioma UK, a national resource centre and registered charity based in Leicester. She says the organisation takes up to 800 calls a year and receives around 1,500 hits per month to its website.
The charity runs annual patient care conferences and lobbies government to raise the profile of the dangers of asbestos, invest in research and improve access to specialist treatment.
Obtaining financial support or compensation following a diagnosis of mesothelioma is vital, says Tony Whitston, chairperson of the Asbestos Support Groups Forum (England). This umbrella organisation aims to put people in touch with support groups or other bodies to help ease the route to benefits and compensation as well as campaigning to improve financial support, treatment and research.
The organisation also liaises with specialist respiratory nurses and lung cancer nurses to ensure a proof of diagnosis form is completed. This form fast tracks claims for industrial injuries, disablement benefit and government compensation.
Solicitor Mr Cass hopes trusts will fulfil their statutory obligations to conduct proper and regular surveys on asbestos in hospital buildings, to ensure that all those who might come into contact with the material are properly warned of its existence and all steps for its safe control in buildings are observed.
He advises nurses to be 'vigilant' about asbestos. 'There is still a risk of it in hospitals and if nurses do have any personal concerns they should not hesitate to report them to the trust.'
The HSE says nurses should report immediately any damage to walls inside the buildings, on the assumption it may contain asbestos. And the RCN says if nurses are worried about asbestos in their working environment or wish to raise concerns they should talk to their union safety representative.
While stressing the need to keep the scale of the condition among nursing 'in perspective', Ms Darlison urges everyone to 'be asbestos aware'.
Ms Nursey wants the government to raise awareness about the dangers of asbestos and to ensure stronger regulatory measures are in place in order to safeguard people, whatever their chosen profession.
With the support of family and friends, she is fighting the disease. Recently she had chemotherapy, which she says was unsuccessful, and is having a rest from treatment until later in the year.
'I'm taking things a day at a time,' she says. 'Some days I go out to the shops and meet friends. Other days I feel too ill to go out.
'It's so upsetting for me, after all these years of nursing, not to be able to enjoy my retirement. This disease has been a devastating blow but you've got to learn to live with it, haven't you?'
Support and information
Asbestos Support Groups' Forum (England). Tel: 0161 953 4037