Advanced Practitioner
Lee is an Advanced Practitioner working in Non-surgical Cancer Services at Torbay & South Devon NHS Foundation Trust.
Lee works at Level 7 across the
four pillars of advanced practice
| Clinical | • Uro-oncology clinic • SACT authorisation clinic • Bone marrow biopsy list • Interventions list • Urology multi-disciplinary team meeting • Oncology ward round & Oncology mortality and morbidity meeting |
| Leadership | • SAFER meeting • SACT & Vascular Access Team clinical leadership. • Senior nursing support • Service development • Governance • Capacity and business planning • Chair of monthly SACT committee meeting |
| Education | • Oncology Nurses Society Passport marker, for SACT trained nurses • Learning and development for junior nursing staff • Support junior doctors working in non-surgical cancer services. |
| Research | • Audit and QI projects • Digital development, member of trust digital council. • SACT clinical trials prescription development |
Why Advanced Practice?
Early on in my career I was inspired by the advanced practice in vascular access. I enjoyed leadership but wanted to remain clinically focused. My role has developed a uro-oncology focus, treating patients with cancer.
Feedback from a Patient: “Thank you for taking the time with me last month to reassure and settle me down about the upcoming treatment, and side effects associated with it. Your calm and caring manner went a long way to making me feel better”
What is the most enjoyable part of your role?
I enjoy managing a caseload of patients and forming therapeutic, trusting relationships with them to enhance their care and outcomes, knowing I have done the best for someone that I can.
Feedback from a Patients Family: “I know my wife was very fond of Lee whose expertise with the ultrasound and draining needle and his ability to make her laugh, helped to greatly reduce her discomfort
Why is Advanced Practice good for patients?
Advanced Practitioners can provide increased accessibility to patient/carer centred care. They have additional skill sets that vary according to their background and experience, e.g. Nursing, Paramedic, Physio. Collaborative working can reduce barriers and improve efficiencies in the provision of care, especially when this involves cross departmental working.
Feedback from a Consultant Colleague: “It is a pleasure to work with Lee who is a conscientious, pleasant and very capable colleague. His contribution to uro-oncology team is very much valued and appreciated.”
How has your role changed and enhanced service delivery?
My role as improved patient access to, and the safety of, interventions associated with side effects of cancer. For example, I provide paracentesis using point of care ultrasound. This is not only safer but more efficient and reduces demand on already overstretched diagnostic services.
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What inspired you to become an Advanced Practitioner?
I tended to identify gaps within the service, when I approached my line manager, she was always supportive of my desire to develop and provide these elements of service.
On reflection, I have worked with a colleagues who were excellent interventionalists, and early on in my career I was inspired by seeing advanced practice roles in vascular access.
Career journey to becoming an Advanced Practitioner:
In 2005 I started inserting peripherally inserted central catheters as an extension of my chemotherapy unit charge nurse role. I quickly realised my passion for interventional work. This ‘snowballed’ to the point where I was informally providing this service across the whole hospital, so I wrote a business case for a vascular access team.
In 2013 the vascular access team was formed, and I split my time between vascular access and developing as a nurse practitioner on the chemotherapy unit. Achieving my non-medical prescribing qualification, expanding my interventional work, and reviewing patients on chemotherapy who became unwell.
2018 threw me a curveball, and I stepped into the Matron post on a fixed term basis, to cover leave. This reaffirmed to me that, whilst I enjoyed leadership, I wanted to remain clinically focused.
2019 I commenced my MSc advanced clinical practice apprenticeship and developed a uro-oncology focus, holding a caseload of patients on cancer treatments, to address some shortfalls in the medical workforce.
What is your current role across the 4 pillars?
Clinical
• Uro-oncology clinic (previously consultant led), patient consultations, assessment, examination and education, consent, complex case management, decision to treat/not treat with systemic anti-cancer therapy (SACT), requesting imaging to assess response or for restaging. Best supportive care.
• SACT authorisation clinic, reviewing complex patient data to form a treatment decision. SACT prescribing, dose alterations according to body surface area, glomerular filtration rate, or toxicity. Defer, omit or stop treatment when appropriate to maintain patient safety.
• Bone marrow biopsy list, supporting diagnostic pathway, high levels of dexterity, clinical knowledge and technical ability. Contributing to specialist education of medical students and new haematology specialist registrars.
• Interventions list, paracentesis, pleural aspiration, dissection & removal of skin tunnelled cuffed central venous catheters & totally implanted vascular access devices. High levels of dexterity, clinical knowledge and technical ability. Contributing to specialist education of medical students, FY1, FY2, ST and specialist registrars.
• Urology multi-disciplinary team meeting. Review of patient disease staging, restaging and treatment planning of new and existing patients. Interdisciplinary working, advanced level nursing representation.
• Oncology ward round, complex case management, ACP representation, personal development opportunity.
Oncology mortality and morbidity meeting, case reviews of death within 30 days of SACT, ACP representation, personal development opportunity.
Leadership
• SAFER meeting – daily service oversight of safety and capacity to deliver SACT.
• SACT & Vascular Access Team (VAT) clinical leadership.
• Senior nursing support, complex case management and acute oncology queries. Regularly use this as a learning/development opportunity for junior nursing staff.
• Senior nurse leads meeting. Service development, governance, capacity planning, business planning.
• Monthly cancer services budget meeting. Resource management, forecasting and development.
• Chair of monthly SACT committee meeting, strategic oversight and service development planning. Governance and capacity planning in response to confirmed and predicted NICE TAs.
• Cancer services business meeting, attend in the capacity of SACT lead nurse & vascular access clinical lead.
• Trust SACT lead nurse representation at combined South West Peninsular, and Somerset, Wiltshire, Avon and Gloucestershire Cancer Alliance Lead SACT Nurse Group.
Education
• United Kingdom Oncology Nurses Society SACT Passport marker, for all SACT trained nurses.
• When providing senior nursing support, I use this as a learning/development opportunity for junior nursing staff.
• Attend and contribute towards ward multidisciplinary meeting, mortality and morbidity meeting, cancer services governance meeting. Reflect on findings to improve services going forward.
• Support junior doctors working in non-surgical cancer services to develop interventional skills.
• Teach vascular access device management to junior doctors as part of their trust wide rolling education programme.
• SPA time for self-directed learning and QI projects.
Research
• SACT & VAT quality improvement projects and audit.
• Healthcare technology and digital development, member of trust digital council.
• SACT clinical trials prescription development and ratification.
• Participate in clinical trials. Review and prescribe for patients on SACT clinical trials.
What is the most challenging part of your role and how have you addressed those challenges?
My role evolved, as a result it has a wide scope. It can be challenging to juggle competing priorities at times. I have to be very organised and agile in the way I work to ensure I optimise my time and provide the best service I can within the constraints of time and resource.
Has your role had an impact on service delivery?
My role has improved patient access to, and the safety of, interventions associated with side effects of cancer. For example, I provide paracentesis using point of care ultrasound. This is not only safer but more efficient, and reduced demand on already overstretched diagnostic services. Patients can self-refer according to their level of symptoms.
I like to think my nursing background and experience brings something extra to my uro-oncology work, using enhanced toxicity assessment skills and management strategies, as well as an empathic approach to gain trust and promote open, honest, and sometimes difficult conversations. This collectively contributes to better patient understanding, reporting, treatment compliance and optimisation, and improved outcomes.
What benefits do Advanced Practitioners bring to patients and your service?
Increased accessibility, patient/carer centred care, additional skill sets that will vary according to advanced clinical practitioners background and experience, e.g Nursing, Paramedic, Physio, etc. Reputation and collaborative working can reduce barriers and improve efficiencies in provision of care, especially when this involves cross departmental working.
What is your future vision for Advanced Practice in your service or role?
My role demonstrates that an advanced practice role in a cancer speciality has a positive impact and improves outcomes. It would be good to add Advanced Practitioners to other cancer sites to ensure that all cancer patients benefit equally. Planning the development of an acute oncology service in conjunction with a same day emergency care unit with an Advanced Practitioner delivering care.
What advice would you give aspiring Advanced Practitioners?
Anyone who has a vision to be an advanced practitioner should build their knowledge base, experience, clinical skills, and interdisciplinary network to lay solid foundations. I would highly recommend the apprenticeship MSc pathway, as this offers continuity of tutors and a logical progression of the subjects studied. I would also recommend accessing some of the excellent academic support services if they have had a break from academic writing.