Dimensions of clinical nurse specialist work in the UK

Authors:
  • ADAlison Leary Oncology Department
    Alison Leary Oncology Department
  • UNUniversity College London Hospitals (UCLH) NHS Foundation TrustHeather Crouch UCLH NHS Foundation TrustAnthony Lezard North London Cancer NetworkChris Rawcliffe UCLH NHS Foundation TrustLouise Boden Corporate Nursing
    University College London Hospitals (UCLH) NHS Foundation TrustHeather Crouch UCLH NHS Foundation TrustAnthony Lezard North London Cancer NetworkChris Rawcliffe UCLH NHS Foundation TrustLouise Boden Corporate Nursing
  • UCUCLH NHS Foundation TrustAlison Richardson Cancer
    UCLH NHS Foundation TrustAlison Richardson Cancer
  • PCPalliative Nursing Care
    Palliative Nursing Care
  • FNFlorence Nightingale School of Nursing
    Florence Nightingale School of Nursing
  • MIMidwifery
    Midwifery
  • KLKings College London
    Kings College London
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Abstract
To model the work of clinical nurse specialists (CNSs) in the UK. This article examines data mined as part of a national project. The Pandora database was initially collected on a Microsoft Office Access database and subsequently, a Structured Query Language database in several iterations from June 2006 to September 2008. Pandora recorded CNS activity as a series of events with eight dimensions to each event. Data from this were mined to examine the complexity of CNS work. This study represents the work of 463 CNSs over 2,778 days in England, Scotland and Wales. Clinical work, including physical assessment, referral, symptom control and 'rescue' work, accounted for a large part of the CNS's role. Administration was the second highest workload, with about half of these administrative tasks identified as being suitable for secretarial staff to undertake. Research, education and consultation accounted for less time. A significant proportion of the nurses' clinical work is undertaken by telephone. CNSs in this study spent much of their time doing complex clinical work. Payment by Results (Department of Health 2006) should recognise the work undertaken by CNSs, particularly that done on the telephone. Complex clinical work by CNSs takes place in many different contexts using a wide range of interventions. The role of the CNS is complex and diverse, making comparisons of it difficult. More research needs to be done in relation to quality, safety and efficiency.