CHOOSING A SPECIALITY

1. CHOOSING A SPECIALITY Annette Vanhein-Wallace Clinical Nurse Specialist Outpatients Parenteral Antimicrobial Therapy (OPAT) Royal Free Hospital RCN JOBS FAIR 2010

2. INTRODUCTION The expansion across the UK of new and extended nursing roles has led to much confusion in the minds of healthcare consumers, employers, nursing specialists and education facilitators regarding the meaning, scope of practice, preparation for and expectations of specialist roles (Daly &Carnwell 2002). The role of the Clinical Nurse Specialist (CNS) in the delivery of direct care is often overlooked or not recognised. Validation of service can demonstrate significant contribution CNS� can make to length of stay and admission avoidance- issues pertinent to out health economy (Kelly &Trevatt 2006) The word �specialist has a nice ring to it. When we specialise in something, whether it is related to a skill, company or hobby, we have knowledge that is above and beyond the base of a particular topic. Becoming a nurse is certainly special. However, specialising in a specific are of nursing can boost your resume and reflect positively on your salary. Money should not always be the motivator.The word �specialist has a nice ring to it. When we specialise in something, whether it is related to a skill, company or hobby, we have knowledge that is above and beyond the base of a particular topic. Becoming a nurse is certainly special. However, specialising in a specific are of nursing can boost your resume and reflect positively on your salary. Money should not always be the motivator.

3. SPECIALIST v SPECIALISED v ADVANCED PRATITIONER Being a nurse specialist means taking on an advanced practice. Royal Free Hospital defines advanced practice as �an aspect of care which may be undertaken by registered nurses and midwives who have undergone the specified training and assessment, accept responsibility for their actions and proven competence to undertake the aspect of care. (Nursing &Midwifery, Advanced Practice (2), Guidelines development Policy 2008) NMC definition of advanced practice requires the nurse to: Carry out physical assessment Decide whether to refer for investigations Make diagnosis Plans and provides care that meets all levels of needs Ensures continuity/follow up Evaluates treatment and makes changes Works independently Ensures best practice. (NMC 2008)

4. RCN Definition of Specialist Nurses CNS� offer complimentary source of care to that offered by medical practitioners and other healthcare providers. CNS�/Advanced Practitioners augment the care that the team can deliver and can also act as primary care providers in their own rights. SO, my definition of a nurse specialist is �one who specialises in a particular are of nursing, caring for patients suffering from diseases such as cancer, Parkinson�s, HIV/AIDS, soft tissue infections; by providing direct patient care and support and can play a vital role in helping improve quality of life through education, management and control of symptoms. In many cases, CNS� involvement and intervention can prevent re- hospitalisation. Roles vary from Trust to Trust Following the publication of the Council for Health Care Regulatory Excellence (CHRE) report on advanced practice, the NMC acknowledges the confusion of nursing; emphasising that safeguarding public implications have not changed. Therefore regulatory bodies have to be in charge of approving standards which registrants will need to maintain their registration. The NMC is working with the DoH on this.

5. WHY SPECIALISE? Who is currently specialising in an area? Who is contemplating/has applied for a specialist ward or post? What do you think are the advantaged/disadvantages of specialising in an area?

6. Searching the field of nursing speciality There are exciting career opportunities. HOSPITAL CNS post examples: OPAT Pulmonary Hypertension Hepatology Cardiac/ Heart failure Patient At Risk of Resuscitation Team (PARRT) Renal Transplant Tuberculosis Nutrition Bone Marrow Transplant Haematology/Oncology Tissue Viability Palliative Sickle cells Diabetes 2.COMMUNITY CNS post examples: Diabetic Tissue Viability HIV/AIDS Cardiac/ heart Tip: Identify what speciality excites and motivates you to do the best!!

7. Recruitment difficulties Lack of applicants- secondary care hesitant to transfer to primary care. Fear it will jeopardise career progression Lack of relevant qualifications Fear of working autonomously Lack of any dynamic professional development/ training Fear of being a loner

8. Experience & Qualification The RCN recommends that would be nurse specialists should undertake a specific course of study at least at honours degree level. What if you have no honours degree? PRACTICAL STEPS Clear job description and career pathway Up to date Advanced Practice document that supports your role and protects your practice Competencies linked to your KSF which reflect what is required for RCN ANP programme. Accreditation of higher education institution courses to demonstrate required RCN standards. Accreditation of Prior ( Experimental ) Learning (AP(E)L) Maybe test the waters- by piloting RCN accreditation for some specialists!

9. RCN�s Core areas of study for specialist nurses Therapeutic/holistic nursing Public health and health promotion Research Organisational, interpersonal and communication skills Accountability- including legal and ethical issues Quality assurance Political, social and economic influences on care Leadership and teaching

10. Annette�s core areas of speciality Honours Degree in Nursing 4 yrs in Band 6 &2 yrs in Band 7 ENB 998 /Preceptor ship &mentorship (teaching medical & nursing staff) Midline & PICC insertions with/without ultra sound machine. Requesting X- rays Running OPAT clinic Counselling Competency based interviewing Advanced Life Support Auditing/Benchmarking Physical Assessment & Diagnosis (Middlesex University) Nurse Prescribing (2011) Masters (2012)

11. Finding the right speciality Consider your ideal job location. Based on your nursing background, you can work in a wide variety of locations including: Airplanes, Army/Police, care homes, hospitals, community, schools Get advise from nurses in certain specialities. Consider stress levels as a factor Learn about the educational requirements Look before you leap: Day long courses Hands on training Job shadowing 1. There are a few key considerations to make. Depending on the area you want to work, certain specialities may be in greater demand. Another issue is that working in a certain place tends to be more stressful than working in others (e.g. prison &hospice v school. 2.It is important to get a perspective from nurses who have experience in a certain speciality. They can provide with some �street smarts� based on their own experiences. This will provide you with a more realistic perspective about the day-to-day realities of working within a particular area. 3. Different specialisations have different stress levels. Many people make the error in assuming that stress is always negative. In fact, some stress is good. Healthy stress makes our bodies and minds more alert to deal with particular situations. However, the amount of stress that different specialities create can vary greatly. Quiet honestly, if you cannot handle stress, then you should not be a nurse. 4. Qualifying as a nurse requires about 3 yrs study. Afterwards, specialisation can require up t0 2-4 years of schooling, depending on the speciality. 5. Just as companies road test products before putting them on the market, you can also test certain specialities before choosing one. Fortunately, numerous nursing programs provide this chance. You could become less interested in specialities that you initially favoured, and more interested in in specialities you initially dismissed.1. There are a few key considerations to make. Depending on the area you want to work, certain specialities may be in greater demand. Another issue is that working in a certain place tends to be more stressful than working in others (e.g. prison &hospice v school. 2.It is important to get a perspective from nurses who have experience in a certain speciality. They can provide with some �street smarts� based on their own experiences. This will provide you with a more realistic perspective about the day-to-day realities of working within a particular area. 3. Different specialisations have different stress levels. Many people make the error in assuming that stress is always negative. In fact, some stress is good. Healthy stress makes our bodies and minds more alert to deal with particular situations. However, the amount of stress that different specialities create can vary greatly. Quiet honestly, if you cannot handle stress, then you should not be a nurse. 4. Qualifying as a nurse requires about 3 yrs study. Afterwards, specialisation can require up t0 2-4 years of schooling, depending on the speciality. 5. Just as companies road test products before putting them on the market, you can also test certain specialities before choosing one. Fortunately, numerous nursing programs provide this chance. You could become less interested in specialities that you initially favoured, and more interested in in specialities you initially dismissed.

12. Getting the experience Learn on the job Take specialist courses Attend practical hands on study days Attend/present relevant seminars nationally/internationally Shadowing medical teams during ward rounds/specialist nurses in the community Liaise with other CNS� in the Trust Use integrated care networks Teach medical and nursing students Contact RCN for further advice

13. OPAT at the Royal Free Hospital Piloted on Bone Marrow Transplant patients between 2004-mid 2006 and treated 100 patients with antivirals Established late 2006 and to date has treated >500 patients; saving the Trust >6000 bed days Patient selection: Patients admitted to hospital with infection requiring long term intravenous antimicrobial therapy Osteomylitis/prosthetic joint infections Endovascular and graft infections Infective Endocarditis Severe soft tissue infections (Cellulitis) Liver abcesses Acceptance of referrals from consultants in agreement with Infectious Diseases team Teach patient/carer/District Nurses to administer medication via PICCs, Midlines, Hickman lines, Porta-caths and peripheral cannulae Consultation with OPAT CNS and Pharmacist weekly and fortnightly by ID RESULTS: IV treatment range from 2-12 weeks. Follow up with oral antibiotics Reduction of PICC and Midline complications (at present 0% infection rate).

14. Specialist career Although a specialist career is focused, it can be very rewarding and varied. In depth knowledge enables you to manage patients more effectively and autonomously. Satisfaction from knowing you are providing the care possible. Close relationship and continuity of care with patients and other healthcare professionals.

15. Conclusion It is difficult to remain motivated at the frantic rate of change in the NHS. CNS� who are fit for purpose should be demonstrating clinical expertise, developing others through education, lecturing, publishing and be relentless in their innovations for quality service. When they ask �are CNSs value for money?�, I think frankly, I�m a bargain! I hope I have inspired you to test drive a new career or to become an expert in your chosen field!

16. References Daly WM, Carnwell R (2002). Nursing roles and levels of practice: a framework for differentiating between elementary, specialist and advancing practice. Journal of Clinical Nursing, 12:158-167 Kelly D, Trevatt P (2006)NHS Finances. Cancer Nursing Practice. 5 (8), 13. Royal College of Nursing (2008) Advanced nurse practitioners- an RCN guide to the advanced nurse practitioner role, competencies and programme accreditation The Nursing &Midwifery Council (2008), The Code: Standards of conduct, performance and ethics for nurses and midwives.