This Article Aims To Explore How Nursing Practice Has Evolve ✓ Solved

This article aims to explore how nursing practice has evolved

This article aims to explore how nursing practice has evolved within a secondary care dermatology outpatient setting in recent years to meet a staffing crisis faced by many dermatology departments, which resulted in some having to close. The article’s focus is on skin cancer and dermatological surgery and will describe the pivotal role nurses play in not only ensuring care needs are met, but in reshaping the service into a superior care model.

The NHS is facing an uncertain future, crippled by increasing financial constraints and population demands. An ageing population is of particular concern for dermatology services and skin cancer care because the incidence in this patient group is high and often difficult to treat. It is estimated that 54% of the population is affected by skin disease and over half of all referred activity to dermatology services relates to skin cancer management. It is well known that early diagnosis in cancer is the key to cure, and all skin cancers, both melanoma and non-melanoma, can be cured if detected early. However, the only detection method available is direct skin examination performed by a trained professional. Examination by a consultant dermatologist is considered to be the gold standard, but, quite simply, there are severe workforce issues in dermatology services and a national shortfall of consultant dermatologists.

Dermatology services have been forced to close their doors, leading to other services becoming overwhelmed with the tsunami of skin cancer that is sweeping its way across the UK. In essence, dermatology services have been struggling to meet population demand and therefore new ways of working needed to be found.

An Extended Scope of Clinical Practice for Nurses

Nurses working in skin cancer services have welcomed the opportunity to develop their skills. Nurse-led care in the field of skin cancer predominantly involves the screening and detection of skin lesions and the surgical sampling and removal of skin malignancies. The concept of a nurse-led skin biopsy service resulted in reduced waiting times for simple biopsies (and complex skin cancer removal), which essentially gave dermatologists the time to manage the more complex cases. Nurses’ surgical skills quickly evolved from simple biopsies to complex skin cancer removal, and now incorporates advanced dermatological surgery. Some advanced skills are not always possessed by all consultant dermatologists.

To demonstrate their competency, nurses must complete a portfolio for each clinical skill. Skills need to be practised until absolute proficiency is demonstrated, and then verified by a consultant dermatologist and underpinned by a university-recognised skin surgery accreditation or trust-agreed minor surgery course. In addition, clinical governance is maintained further with an agreed timetable of regular direct observation of procedural skills and mini-clinical evaluation exercise assessments, a process that mirrors the training package of a dermatology specialty registrar.

Skin Cancer Screening

Nurses working in skin cancer screening clinics have developed skills that are fast evolving, but little is understood about this area of nursing development. Many nurse-led clinics are protocol driven and there is no standard of practice for nurses independently managing skin cancer in the UK. This element of extended nursing practice is deemed controversial and is largely driven by medical clinicians and management teams in individual trusts. Essentially, if demand dictates and the nursing team demonstrates competence and a will to progress, then nursing practice will develop.

Improving Service Delivery

It could be argued that nurses are plugging the gaps rather than being encouraged to develop their practice. However, the benefits of advanced practice in skin cancer nursing is evidenced by cost savings, waiting-list reduction, and improved overall productivity and continuity of care. Furthermore, nurses are generally easily accessible and approachable with excellent communication skills and take a holistic approach to care delivery.

Quite simply, a nurse demonstrating such advanced practice skills is a practitioner who holds the same level of competence to diagnose and manage skin cancer as a consultant dermatologist, but also has the inherent compassion and care of a nurse that was instilled during their nursing training. Therefore, a nurse performing at this level can truly make a difference not only to the care provided, but to the overall experience of patients and their families.

Nurses who possess advanced knowledge and skills have the ability to save a life. Often patients do not think one particular skin lesion is anything to worry about and do not ask for it to be assessed by the screening clinician at their initial consultation. Yet the proficient nurse will spot that this lesion is in fact a melanoma during the routine skin biopsy for another lesion.

What the Future Holds

Despite what has been described in this article, and what is being demonstrated as routine practice throughout the UK, there are major gaps in practice development and care provision. The UK currently employs an array of specialist nurses in skin cancer care, but there are vast inconsistencies in the roles and responsibilities they hold. Role titles such as nurse practitioner and clinical nurse specialist are often used interchangeably but there can be differences in the care they deliver.

Therefore, a standardised framework for clinical progression is required to ensure clinical governance remains robust, trusts can recruit into posts and the longevity of service provision. The aim for the future is to work collaboratively with other centres and produce a nationally agreed training syllabus, competency pathway and agreed scope of practice for each nursing level.

Conclusion

In conclusion, the role of nurses within dermatology outpatient settings has expanded significantly in response to the care delivery challenges faced within the NHS. This evolution not only enhances patient care through timely intervention and management but also underscores the vital contributions nurses make in addressing service demands. As practice continues to evolve, ongoing assessment and development of nurse competencies will be crucial in sustaining high-quality care in dermatology.

References

• BJN Eedy D. The crisis in dermatology. BMJ. 2015;350:h2765.
• Godsell G. A nurse-surgical post cuts waiting times and extends nurses’ skills base. Professional Nurse. 2004;19(8).
• Harris JM, Salache SJ, Harris RB. Can internet based continuing medical education improve physicians’ skin cancer knowledge and skills? J Gen Intern Med. 2001;16(1):50-56.
• Jones N, Colver GB. Skin cancer nurses: a screening role. Journal of Clinical & Experimental Dermatology Research. 2011;2(6).
• Katris P, Donovan RJ, Gray BN. Nurses screening for skin cancer: an observational study. Aust N Z J Public Health. 1998;22(3 Suppl).
• The King’s Fund. How can dermatology services meet current and future patient needs, while ensuring quality of care is not compromised and access is equitable across the UK? 2015.
• Lawrence CM. An introduction to dermatological surgery. London: Churchill Livingstone; 2002.
• Loescher LJ, Harris JM, Curiel-Lewandrowski C. A systematic review of advanced practice nurses, skin cancer assessment barriers, skin lesion recognition skills, and skin cancer training activities. J Am Acad Nurse Pract. 2011;23(12).
• Machin C. Can a nurse practitioner independently diagnose skin cancer? Dermatology Nursing. 2017;16(3):10-15.
• Wingfield C, Davies K, Levell NJ, Skellett AM. Dermatology nurse consultant succession planning: an introduction to the nurse registrar role. Dermatology Nursing. 2018;17(3):31-38.