EAUN fellowship report – London

Objective: To learn and experience the role of a clinical nurse.

I specialise in providing care and support to patients with urological diseases, with a focus on prostate cancer (PCa). It is important to me to offer comprehensive and continuous care to patients and their families throughout their cancer journey.

Since last year, the Urology Clinic at the University Hospital in Zurich has been restructuring to adapt to new requirements and approaches in the care and treatment of PCa patients.

A new clinical nurse role was introduced to provide high quality, professional care to patients and their families. The project is still in development, with a few steps remaining before full implementation. This is a new concept in Switzerland and requires research and comparison opportunities with nursing staff abroad who have many years of experience. This is why I chose to do an exchange in London, because the clinical nurse role has long been successfully implemented within the UK healthcare system.

I hoped that the exchange would allow me to further develop my advanced practitioner nurse role at the University Hospital Zurich. I applied to study at UCLH in London because I believed I could learn from other clinical nurses in urology and integrate my experiences into daily practice. It was also important for me to network and exchange ideas with other urology professionals in order to support each other. The aim of my fellowship was to gain insights and knowledge about:

• Development of the nurse qualification
• Role and skills of a nurse practitioner and clinical nurse
• Organisation of daily work and care in the patient’s ward
• Care and support of PCa patients

Fellowship at UCLH London
I had the opportunity to spend four days at UCLH in October. My visit was very well organised by Hilary Baker (Lead Clinical Nurse Specialist for urological cancers). I spent three days at Westmoreland Street, UCLH and a ½ day at the MacMillian Cancer Centre. Both are based in the heart of London and are part of University College London Hospitals NHS Foundation Trust.

At Westmoreland Street, I met the urology department and had a visit to the RALP robotic Theatre, followed by a focal meeting, and MRI meeting. I had the opportunity to attend focal theatre, and meet with the andrology clinical nurse, as well as join a decision-making clinic.

At the MacMillan Cancer Centre, I met the focal team and attended a uro-oncology meeting. I also spent time learning about robotic clinical governance, and shadowed the prostate CNSs in the office.

Westmoreland
Urology services are offered at Westmoreland University College Hospital and include the diagnosis, treatment and prevention of diseases of the urinary tract in men and women and the male reproductive organs. Westmoreland covers the entire northern part of England in the surgical treatment of PCa patients. Between two and three patients are treated surgically (prostatectomy) every day.

Before the operation, the responsible urologist informs patients about the operation, risks and possible side effects. The patients are then cared for by clinical PCa nurses until the operation, at the in-patient area and aftercare. Compared to Switzerland, patients receive full care and advice from a clinical nurse. This makes it possible to discharge the patient home one day after the radical prostatectomy.

On my first day I accompanied a clinical nurse and saw first-hand the care given to patients before, during and after radical prostatectomy. The clinical nurses gives patient all the necessary information before the operation. They support the surgeon during the radical prostatectomy and visit the patient with the urologist after the surgery.

Before the patient can decide on a therapy, they are fully advised by the responsible urologist and clinical nurse and informed about the therapy options, risks and side effects, as well as possible support in the event of side effects. Depending on the aggressiveness of the tumour, the patient has various treatment options available, which are discussed on the tumour board after the diagnosis has been made.

Clinical nurses and radiologists and oncologists take part in the tumour board. They discuss the best possible therapy options for the patient and support them in making the therapy decision. My experience has shown that patients do not want to decide on therapy straight away and still need time to think about it. During this time, the clinical nurses serve as personal contacts for the patient.

Since COVID-19, conversations with patients often take place on the telephone. Before COVID, it was face-to-face meetings. With patients needing to travel from all over England, it is a positive and convenient way for the patient to now receive assistance by email or telephone.

MacMillan Cancer Centre
The MacMillan Cancer Centre has become a specialist centre for the treatment of urological cancers. Iaccompanied a clinical nurse and an oncologist in consultation hours for half a day. The clinical nurse and the oncologist share a ward room together. There is always regular communication and exchange of information about the patient and his treatment. Clinical nurses accompany and advise patients. They are the personal contact for the patient.

CNS Urology at the UCLH
My experience showed that the clinical nurses at UCLH in London are very well-trained nurses and have extensive experience in their urological specialty. Compared to Switzerland, clinical nurse specialisations in the urological field already exist in England. Most clinical nurses have a Master of Science degree or are still in training. Every clinical nurse has a medical mentor who supports and trains them. It is very impressive how the collaboration between the doctors and clinical nurses works. The clinical nurse’s work includes caring for the patient from the moment the diagnosis is made, during therapy, and in follow-up care. They are the ongoing contact persons for the patients. They are in constant communication with each other, with the multidisciplinary team, doctors, communities and home care facilities. Due to their experience and special knowledge, the clinical nurse can provide the patient with professional and correct treatment. They organise and coordinate the patient’s treatment and ensure that the patient receives the full care, information and support needed.

What I learned from this experience
It was exciting to see the potential of the clinical nurse role and the great services they provide. It is great to see how clinical nurses, doctors and multidisciplinary teams work together to ensure the patients receives comprehensive care. An important aspect is the comprehensive treatment path. The patient is fully cared for and accompanied from the time of diagnosis, during treatment and aftercare. The patient always has a contact person.

This is a service that unfortunately does not yet exist in Switzerland and is of great importance for patients. I will take these positive aspects into my everyday practice and try to implement them. It was an impressive time, I learnt a lot, and only experienced positive things. I met very nice people who shared their knowledge, skills and abilities with me. I would like to thank everyone again and hope to encourage other EAUN members to apply for a scholarship programme.

My sincere thanks go above all to the EAUN, which gave me the opportunity to experience such a educationally rewarding fellowship

Mrs. Pia Albin, Advanced Nurse Practitioner, Dept. of urology, University Hospital Zurich (CH)