The importance of nurses in cancer care

Abstract

In early June, 2015, it became apparent that the UK National Health Service (NHS) had spent £3·3 billion on temporary nurses' agency fees in the past financial year. Health Secretary Jeremy Hunt ascribed this increased use of agency nurses partly to hospitals' response to the report into the Mid Staffordshire NHS Foundation Trust that investigated unacceptably poor levels of care in that region's health-care provision, and showed that this was partly related to chronically low staffing levels. Declining numbers of nurses is a global problem, and all the more so given mounting evidence showing that involving nurses in more specialist roles, such as in nurse-led clinics for patients with cancer, improves patient outcomes. Nurses are vital in delivering the best possible health care. A 2002 article in JAMA showed a clear association between a nurse being assigned more patients and increased risk of 30-day mortality. Increasingly, there is also recognition of the important role that nurses have in caring for patients with cancer. The upcoming European Cancer Congress this autumn (Vienna, Austria; Sept 25–29, 2015) has issued a special call for oncology nurses, citing their attendance as a priority for the organising committee, and including oncology nurses in many of their multidisciplinary tumour board discussions. Indeed, there have been calls for specialist oncology nurses to lead follow-up clinics in concert with physicians for patients with head and neck cancer. Data also show that such oncology nursing clinics, despite their heterogeneous implementation, improve both continuity of care and patient compliance and anxiety. Despite increased demand for nurses to fill this growing tranche of specialised roles, the number of people entering the profession is decreasing. An article in the Washington Post suggested that, in the USA, both baby-boomer nurses and their instructor counterparts in universities are reaching retirement, without an influx from the next generation. The shortage of teaching nurses is especially problematic because without qualified faculty, those who want to become nurses might be unable to do so—the American Association of Colleges of Nursing found that about two-thirds of US nursing schools had to turn away qualified applicants because of shortages in teaching staff. The American Oncology Nursing Society has issued a position statement of concern, stating that they believe that the nursing shortage will negatively affect cancer care, and calling for changes to be made at both an educational and a legislative level. The position statement also highlighted difficulties with nursing retention. Aside from the professional burnout that endangers many medical specialists, the nature of nurses' work puts them at danger of developing occupational-based hazards such as muscoskeletal disorders (nursing is ranked sixth out of all professions for this risk), and contact dermatitis brought about by stringent hand-washing measures. Furthermore, the job comes with long, often antisocial, hours and poor remuneration. Efforts by nursing unions to increase remuneration are difficult, given that the critical nature of the care that nurses provide makes it hard for unions to engage in industrial action to demand better pay. However, some unions have had to resort to such action—eg, nurses in Victoria, Australia, successfully staged walk-outs in 2012, winning them a 14–21% pay rise from the government. Other regional unions around the world have threatened to follow suit. An editorial in the Nursing Times in the UK on June 3, 2015, called for nurses to act to protect the right to strike, citing the refusal of the UK Government to agree to a 1% pay rise recommended by the NHS Pay Review Body. A crucial factor contributing to the chronic shortage of nurses on wards is the issue of job losses from national health-care systems. This is partly driven by cost-cutting measures—eg, in the UK, although estimates vary, there have been about 6000 permanent nursing posts cut since 2010 and a reduction in the number of nursing training places. The abrupt suspension of a National Institute for Health and Care Excellence guidance report on safe nurse staffing levels also shows a lack of value for the work of nursing staff. There is much evidence showing that chronic shortages in nurses worldwide increase workload burdens, which in turn causes high levels of burnout and job dissatisfaction. The fundamental disconnect between the number of nurses leaving the profession versus those entering, and the number needed in patient care versus those that payers wish to underwrite needs urgent resolution. As demand for nurses taking specialist roles in cancer care rises to combat the increasing burden of disease, it is time that nurses' critical role in all aspects of patient care is explicitly acknowledged through demonstrable change.