Nurse specialists: much more than just a friendly face
Reproduced from Issue 104 of Arthritis Today
When arthritis patients need a reassuring chat about their condition –
who are they going to call?
Not their rheumatologist, that's for sure. Probably not their GP either – too many people still don't like to 'bother the doctor'.
No, the person they are most likely to ring is the rheumatology nurse specialist, one of a once rare breed of dedicated, experienced senior nurses, who are increasingly being recognised as an invaluable part of any rheumatology team.
The RNS, also known as a clinical nurse specialist or practitioner, is the lynch pin of any in or out patient set-up; the first port of call for all recently diagnosed patients, and, over the years, the one with whom they will undoubtedly have the most contact.
"Ideally, every rheumatology department would have an RNS, it's a central role," explains Jackie Hill, one of the most senior rheumatology nurse specialists in the country. Jackie was one of the very first RNSs, and, along with colleagues at the Rheumatology and Rehabilitation Research Unit in Leeds, has done much to expand and develop of the role over the past 18 years.
"The nub of the post is patient education, and we give patients a great deal of support. We help them to come to terms with their diagnosis.
"We help people with their medication, and with coping strategies. We do a lot of counselling, as they often become anxious and depressed. If they have a lot of pain and stiffness we can help with relaxation, and give them access to physiotherapists and occupational therapists. Basically we have a pivotal role, and because we work so closely with rheumatologists we can take some of the pressure off them.
"Many of us have patient help lines, and they really are a life-line for many people. They can pick up the phone and talk about anything, and they find it very comforting."
Jackie Hill has long been a powerful advocate for the RNSs, and for the need for these highly experienced senior nurses to be granted greater status within their field. One of ways this could be achieved, she believes, would be to build up the academic side of rheumatology nursing – ultimately creating professorial chairs.
There are, after all, already Professors of Nursing, and of Midwifery. Jackie also points out that it wasn't until arc established chairs of rheumatology back in the 1950's that rheumatology was taken seriously as a proper medical speciality.
Explains Jackie: "When I started out 18 years ago in Leeds, there weren't any RNSs, the only nurse specialist was a diabetes nurse, and the role really developed on demand from patients who were on clinical drugs trials. We realised there was so much we could do for the patients, and the whole thing sprang from that.
"But because it started in a very unstructured fashion, there is still no particular career pathway in rheumatology."
This has led to the unsatisfactory situation in which grade E, F or G nurses are doing the work of a grade H nurse specialist – doing a great deal of extra work and taking on much more responsibility without being adequately paid. Even nurses who take it upon themselves to go on training courses to gain their extra qualifications don't automatically qualify for a pay rise.
"It's not acceptable for nurses to work so far outside the role they are being paid for, and my anxiety is that as long as they continue to do it, then trusts will take advantage of that and will not want to give them extra," says Jackie Hill. "It devalues our role. Nurses always want to give the best quality of care to their patients – that's why they become nurses – but they are penalised for it financially."
A new initiative by arc could help to establish nursing as an academic speciality, as well as a vocation.
After
wide consultation, it is setting up a pilot scheme of three five-year
lectureship and senior lectureship posts in academic nursing or related
fields. Universities will be invited to submit bids for the posts, which
will be funded by the charity. Successful candidates will have a higher
degree or a good track record in research.
Jackie Hill, who is also a lecturer in rheumatology nursing, is herself carrying out some interesting research which could help to confirm the worth of the RNSs.
With a three-year research grant of more than £100,000 from arc, she is investigating whether 180 patients with rheumatoid and osteoarthritis do better when treated at a rheumatology nurse practitioner clinic (she runs them twice a week at Leeds General Infirmary), compared to standard outpatient care provided by junior hospital doctors.
Earlier research findings suggest that those patients who attend RNS clinics do fare better.
"As the workload in the majority of rheumatology departments has increased, and the hours that junior doctors are required to work has reduced, the role of the specialist nurse has expanded, and many rheumatology departments now employ nurses to manage their own caseloads," says Jackie.
"Nurses now incorporate some of the technical and patient management skills of the doctor, and nurse practitioners are considered to be essential to the smooth running of many rheumatology departments."
It seems only fair that these highly experienced nurses should be accorded the status and respect they have long been due. Otherwise young ambitious nurses will end up leaving the profession in even greater droves than at present.
"My fear is that we have got a lot of young nurses in their mid thirties who have nowhere else to go in their careers," says Jackie. "They will not stay – unless we can offer them something else."
