The EAU and the EAUN have embarked on a long-term plan to effectively boost the collaboration of urology nurses and urologists, while at the same time focusing on the challenges posed by cultural diversity across Europe.
The EUT spoke to EAU Secretary General-Elect Prof. Chris Chapple and EAUN Chair Lawrence Drudge- Coates regarding the goals of the +1 Campaign, to review the potential obstacles to any programme directed at the education of European nurses. The question is how to reach the goal of best integrating the work of urologists and nurses in achieving optimal patient care. Below is the edited transcript of the Q&A interview with Prof. Chapple and Mr. Drudge-Coates:
Q: In what specific ways can the teamwork between urologists and urology-specialised nurses be further improved considering that more clinical tasks are being performed by nurses?
Drudge-Coates: The purpose of the +1 campaign is for clinicians to invest in their clinical staff ( i.e. urology nurses) as part of a multiprofessional approach to help optimise patient care through education – the team being only as good as the weakest link. For urologists their role is often very finite but for the nurses it’s how nurses can impact on, for example, the initial assessment diagnosis, follow-up care and long-term management and their roles alongside other areas like oncology, etc.
However not all urology nursing areas are as developed and as new treatments occur nurses need to know about these as they are often involved in their delivery. The focus of education through the EAUN and the +1 campaign is to provide education either through online courses, or the annual EAUN meeting. The +1 campaign recognises that while urology nurses and urologists have different roles, it’s the recognition that they are working towards the same goal of optimising patient care.
Chapple: Accredited education and training are an important potential in order for nurses to be signed off, but the tasks and subjects tackled will be influenced by the individual health care system that the nurse works in. Much of the training at present is on a local or ad-hoc basis rather than being based on national standards for nursing.
Nevertheless currently certainly in our health care system, it produces the desired outcome for any local needs. In the UK nowadays, there are more training options being offered to nurses because of the pressure on clinical services and need to have more nursing colleagues involved more directly in aspects of urological care which in the past were considered to lie within the realm of the urologist. I realise that this is not considered appropriate or necessary though in a number of other European healthcare systems.
Q: In your respective clinics, have you seen more training opportunities or education programmes in recent years being offered to nurses? If yes, what was the impact on the daily work routine and if there are none, what could be the obstacles? Drudge-Coates: Yes, more and more courses are being made available but are not urology nursingspecific. They are also costly and can be difficult to access. Since nurses are unable to take time off, they often have to pay for these courses themselves which I see as counterproductive when this education will positively impact on patient care and treatment outcomes.
The EAUN bridges this gap by providing up-to-date nursing education. For example the Evidence-based Guidelines for Best Practice in Urological Care cover a number of topics including catheterisation. In my own clinic, with rapid advances in treatment, there is the need to always be ahead of the game in terms of education – but it is difficult to get time off and other ways of getting this education have to be looked at.
Chapple: The amount of work that we are trying to do has been gradually increasing because of increased demand for urological services – particularly with the aging population and therefore the extended role of nursing colleagues has become important in helping us to deal with the daily work routine and provide the best quality of care, in particular relating to follow up management, diagnostic care and counselling. This (+1 Campaign) therefore in our context would be considered to be a very positive initiative.
Q: The EAUN as an international organisation faces the challenge of addressing the concerns of nurses coming from various cultures and in a region where language and mobility present obstacles. In what ways can the EAU and the EAUN work together to offer education and training programmes?
Chapple: The major challenges the EAUN has in addressing the ideal role for nurses from different cultures and regions are as follows. Firstly, relating to linguistic issues. Secondly, to the way in which the local urological practice is structured, which is dependent on the number of urologists per capita in the population and the way in which healthcare is reimbursed, in particular whether there is direct payment to doctors per case, or whether as part of a national health system. Doctors are usually salaried in the government sector in a number of countries such as the UK and are therefore only too grateful for help in dealing with the workload in the most effective fashion.
Drudge-Coates: There will always be challenges to meeting the needs of nursing education. The benefit of a EAU-EAUN approach allows the potential for areas of education to be highlighted through existing EAU relationships with national organisations, where there is no urology nursing society. Thus, it is important for the EAU to advocate not just the development of urologists but also urology nurses as a multiprofessional approach to care. There are huge opportunities to collaborate and complement existing meetings held by the EAU or for the EAU to advertise the role of the EAUN at these meetings. Ultimately, we have to listen to our members to determine what their needs are. We have to be flexible, current and innovative.
Q: Can you cite specific examples of good hospital practices from your experience where urologists and nurses effectively complement their work to achieve better or optimal patient care?
Chapple: It is very clear the extended role of nurses has proved to be enormously successful in the UK where nurses deal with catheter care and continence management. In hospitals, nurses can prescribe drugs after suitable certification and can provide specialist roles, particularly in oncology and continence management. In addition, nurses can carry out a number of procedures, not only relating to catheters and bladder instillations, but also in the context, for instance, of conducting urodynamic evaluations and minor procedures such as cystoscopies under local anaesthesia. There is also the potential for nurses to be involved as surgical assistants.
Drudge-Coates: In my experience, urology nurses are a part of the team for robotic surgery preoperatively, during surgery and postoperatively, and in stream-lining patient care, providing consistency in patient care and follow-up as part of the urology team approach. They provide clinical input for oncology patients managed initially by urologists. They work alongside urologists when patients are given their diagnosis by providing support and organising timely approaches to diagnostic investigations.
Q: More and more urology procedures use minimal invasive technology which lead to clinical practices where nurses assume a crucial role. Do you think this challenge is being systematically addressed by hospital decision-makers and professional organisations?
Drudge-Coates: I don’t think this challenge is being met consistently by hospital decision-makers and this relates to providing the necessary training. So often there is an imbalance in the training given in one hospital compared to another. There is a need for consistency. For nurses, there is a greater need for protocol-led or clinical assessment competencies to be obtained and the necessity to standardise approaches, where possible. This is where organisations can help in education and competency development which is recognised as the standard – and again of paramount important is the EAU-EAUN collaboration.
Chapple: The EAU and the EAUN should work together to identify the perceived needs in terms of education and training for nurses in different cultural settings, rather than trying to dictate a model which is based on the personal experiences of particular individuals involved in running either of these organisations. The challenge is that there is disparity across Europe in terms of the way in which urology is provided and funded.
Q: There is the challenge of cost-cutting among hospitals and lack of personnel across Europe. At the same time there is the pressure for more efficient work procedures. How would the EAU and the EAUN address these issues?
Chapple: The integrated approach between nurses and urologists working closely together is very successful in our system. In particular, nurses also have the opportunity to take more time to discuss matters with patients and their role in counselling is very important, particularly those related to cancer and surgical procedures, such as for stress incontinence, reconstructive urology, urinary diversion and stoma care. The EAU and the EAUN are working together to formulate policies; but recognise that it is essential to work CLOSELY with the National Urological Societies to address the issue of how best to deliver support to urological nurses in each individual country. This is considered to be such an important issue that it will be an important point of discussion at this year’s EAU National Urological Societies Meeting.
Drudge-Coates: The work force issue is one of the ever growing problems that we face. We have to consider current clinical roles for urology nurses perhaps more, for example, in hybrid oncologyurology nurses role (across specialities). We also have to consider how we protect urology as a speciality and the specialised work force required and how we develop newly qualified nurses in urology areas and core training needs so that skills are transferable across the European Union. These discussion are already taking place and the EAUN is involved.
Q: Finally, how would you envision the future of collaborative teamwork among urologists and nurses? Do you expect tangible achievements in the next five years or would it take some time before real changes can be realised?
Drudge-Coates: Urologists need to invest in the education of their nurses such as supporting them for EAUN membership and not assume it’s being done or leave it to their managers. There is a need for a change in mind-set, change in pre-conceived ideas for urologists to look outside what they perceive as the roles of nurses, and consider the possibilities of what the role of urology nurses could be. Changes have already happened but it’s how urologists can champion the role of their urology nurses that will maintain this momentum.
Chapple: Certainly, there is a lot to do and achieve and we are basically building the support systems in the best possible way that we can. This, of course, takes time. The potentials are there, we just need to create bridges and effective links and continue the dialogue, and widen our understanding of the challenges and their possible solutions based on realistic expectations. To reiterate my previous comment, the EAU should closely collaborate with the EAUN by identifying the needs in education and training for nurses in each country, but within the context of Europe’s diverse cultural settings and in close collaboration with each Urological National Society.