Clinical nurse specialists in palliative care. Part 3. Issues for the Macmillan Nurse role

Abstract

The remit and boundaries of the Macmillan Nursing role in the UK have been called into question recently by a number of policy-driven changes. The rapid appointment of tumour site-specific nurses and the development of posts for palliative medicine, stemming originally from the Calman-Hine recommendations for reorganizing cancer services, have created unparalleled challenges of adaptation to new working practices and procedures. The extent to which Macmillan Nurses are adapting to these new demands was addressed as part of a major evaluation study of UK Macmillan Nursing in 12 sites commissioned by the UK charity Macmillan Cancer Relief. This paper draws upon semi-structured interviews with Macmillan Nurses (n = 44) and their key colleagues (n = 47). We found that differences of expectation between Macmillan Nurses and their managers about the appropriate focus of their work lead to problems of role ambiguity and role conflict; that Macmillan Nurses lack resources with which to develop an educative and consultative role and yet substitute for inadequacies in skills and knowledge of other health care staff; and that problems are associated in co-working with newly appointed cancer site-specific nurses and palliative medicine colleagues. Macmillan Nursing has a crucial role to play in meeting the objectives in the NHS Cancer Plan. However, in order to ensure that their expertise is used efficiently and effectively, there is an urgent need to clarify the nature and scope of the Macmillan Nurse role, to attend to issues of team working and to improve the skills of nonspecialist staff in palliative care.

Preparation for cancer care: Perceptions of newly qualified health care professionals

“…The nursing staff were uncertain of their confidence to work as part of a cancer care team. The latter is unsurprising as role ambiguity and conflict between nurses, doctors and other health care professionals have been topical within the field of cancer care (Seymour et al, 2002). This lack of clarity have sometimes been perceived as detrimental to patient care and management of symptoms (Sasahara et al, 2003).…”

“…However the focus lies predominantly on the education and training of doctors and nurses (DOH, 2000a, b;Llamas et al, 2001;RCN, 2003) and to a lesser extent, other professionals such as social workers, physiotherapists and occupational therapists who make up the multiprofessional team, frequently perceived as key to the delivery of quality cancer care. Moreover, there is evidence to suggest that successful team working remains hindered by confusion over the skills and knowledge of different health care professions (Newall and Matthew, 1997;Bliss et al, 2000;Seymour et al, 2002;Sasahara et al, 2003).…”

The Importance of Palliative Care in Urology

“…Ideally, a doctor or nurse would be nominated for special responsibility for urology, joining daily ward rounds and sitting in on certain clinics. There is also clearly scope for attachment of a Macmillan nurse to the urology service [5] , and this is presently available in some hospitals.…”

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion

“…A review of these roles in 2002 found that as a result of changing models of cancer care and the rapid introduction of new nursing roles, there was a need to clarify the scope of the role in order to use their expertise most effectively (Seymour et al, 2002). Over recent years there has been an increasing interest in developing advance practice roles that focus more on clinical assessment, diagnostic reasoning and prescribing, traditionally the domain of medicine.…”

“…However, in more recent times it has been argued that the dominance of the biomedical model has led to the overmedicalisation of death and dying and an erosion of this unique palliative care philosophy. (Clark, 2002) In order to be accepted as an authentic area of medicine in mainstream healthcare, the development of was inevitable, and this specialisation has been underpinned by a biomedical approach to health and illness (Clark, 2002). In a similar fashion, palliative care nursing has embraced a model of specialist practice and knowledge which has become distinct from other areas of nursing (A national professional development framework for palliative care nursing in Aotearoa New Zealand, 2014;Canning et al, 2005).…”