Editorial
The importance of nurses in cancer care
In early June , 2015 , it became apparent that the UK National Health Service ( NHS ) had spent £ 3 · 3 billion on temporary nurses ’ agency fees in the past financial year . Health Secretary Jeremy Hunt ascribed this increased use of agency nurses partly to hospitals ’ response to the report into the Mid Staffordshire NHS Foundation Trust that investigated unacceptably poor levels of care in that region ’ s health-care provision , and showed that this was partly related to chronically low staffing levels . Declining numbers of nurses is a global problem , and all the more so given mounting evidence showing that involving nurses in more specialist roles , such as in nurse-led clinics for patients with cancer , improves patient outcomes .
Nurses are vital in delivering the best possible health care . A 2002 article in JAMA showed a clear association between a nurse being assigned more patients and increased risk of 30-day mortality . Increasingly , there is also recognition of the important role that nurses have in caring for patients with cancer . The upcoming European Cancer Congress this autumn ( Vienna , Austria ; Sept 25 – 29 , 2015 ) has issued a special call for oncology nurses , citing their attendance as a priority for the organising committee , and including oncology nurses in many of their multidisciplinary tumour board discussions . Indeed , there have been calls for specialist oncology nurses to lead follow-up clinics in concert with physicians for patients with head and neck cancer . Data also show that such oncology nursing clinics , despite their heterogeneous implementation , improve both continuity of care and patient compliance and anxiety .
Despite increased demand for nurses to fill this growing tranche of specialised roles , the number of people entering the profession is decreasing . An article in the Washington Post suggested that , in the USA , both baby-boomer nurses and their instructor counterparts in universities are reaching retirement , without an influx from the next generation . The shortage of teaching nurses is especially problematic because without qualified faculty , those who want to become nurses might be unable to do so — the American Association of Colleges of Nursing found that about two-thirds of US nursing schools had to turn away qualified applicants because of shortages in teaching staff . The American Oncology Nursing Society has issued a position statement of concern , stating that they believe that the nursing shortage will negatively affect cancer care , and calling for changes to be made at both an educational and a legislative level .
The position statement also highlighted difficulties with nursing retention . Aside from the professional burnout that endangers many medical specialists , the nature of nurses ’ work puts them at danger of developing occupational-based hazards such as musco skeletal disorders ( nursing is ranked sixth out of all professions for this risk ), and contact dermatitis brought about by stringent handwashing measures . Furthermore , the job comes with long , often antisocial , hours and poor remuneration . Efforts by nursing unions to increase remuneration are difficult , given that the critical nature of the care that nurses provide makes it hard for unions to engage in industrial action to demand better pay . However , some unions have had to resort to such action — eg , nurses in Victoria , Australia , successfully staged walk-outs in 2012 , winning them a 14 – 21 % pay rise from the government . Other regional unions around the world have threatened to follow suit . An editorial in the Nursing Times in the UK on June 3 , 2015 , called for nurses to act to protect the right to strike , citing the refusal of the UK Government to agree to a 1 % pay rise recommended by the NHS Pay Review Body .
A crucial factor contributing to the chronic shortage of nurses on wards is the issue of job losses from national health-care systems . This is partly driven by cost-cutting measures — eg , in the UK , although estimates vary , there have been about 6000 permanent nursing posts cut since 2010 and a reduction in the number of nursing training places . The abrupt suspension of a National Institute for Health and Care Excellence guidance report on safe nurse staffing levels also shows a lack of value for the work of nursing staff .
There is much evidence showing that chronic shortages in nurses worldwide increase workload burdens , which in turn causes high levels of burnout and job dissatisfaction . The fundamental disconnect between the number of nurses leaving the profession versus those entering , and the number needed in patient care versus those that payers wish to underwrite needs urgent resolution . As demand for nurses taking specialist roles in cancer car e rises to combat the increasing burden of disease , it is time that nurses ’ critical role in all aspects of patient care is explicitly acknowledged through demonstrable change . ■ The Lancet Oncology
For more about the Mid Staffordshire report see http :// www . midstaffspublicinquiry . com /
For more on mortality associations with nursing see JAMA 2002 ; 288 : 1987 – 93
For the article in the Washington Post see http :// www . washingtonpost . com / news / to-your-health / wp / 2015 / 06 / 05 / the-nursingshortage-and-the-doctorshortage-are-two-very-differentthings /
For the Nursing Times editorial see http :// www . nursingtimes . net / opinion / editors-comment / take-action-to-protect-theright-to-strike / 5085431 . article ? blocktitle = Editor % 27scomment & contentID = 7874
Thomas Fredberg / Science Photo Library www . thelancet . com / oncology Vol 16 July 2015 737