Tela Jiawook-Brooks reflects on her first year as Haematology Clinical Nurse Specialist (CNS) at St Richard’s Hospital, Sussex University Hospitals NHS Foundation Trust. Here she describes her work, its impact on patients, and how she sees the role developing. She also gives hints and tips for other nurses starting out as a CNS.
How would you describe your role as a CNS?
I coordinate patients’ care, working to make their myeloma journey as smooth as possible and help put their mind at rest when they have worries or concerns. I am patients’ first contact for queries and an important link between them and consultants. I filter questions so patients can get answers to questions, reassurance and advice as quickly as possible. This in turn helps reduce the workload of the medical staff. Being a CNS is a bit like being a problem-solver and fixing a puzzle. Sometimes there are immediate solutions and sometimes you must be more patient and wait for longer-term results.
How does your previous nursing experience help?
My first job was on mixed cell haematology ward which gave me a good background in haematology and broadened my knowledge of both malignant and non-malignant haematology. I went on to work for several years on a chemotherapy day unit. This means I have a good understanding of a variety of treatments and can use my clinical experience to support patients. My chemotherapy knowledge and skills mean I can reassure patients about things that are normal and suggest tricks and tips to help them manage side effects. I go through their medications with them, ensuring they know what to take and when. I try to reduce polypharmacy, which can be an issue, particularly for elderly patients.
What attracted you to the CNS role?
I loved my previous role as a chemotherapy nurse, as it gave me the opportunity to get to know patients over time and provide continuity of care. However, I realised that there was only so much I could do for patients within my day unit role. Becoming a CNS means I can use my knowledge and experience to support patients at all stages of their disease, whether they are on or off treatment. Myeloma attracted me as a speciality because myeloma patients are in our care for the long-term, which makes it possible to build a therapeutic relationship and really make a difference.
What has your first year been like?
I have been in the role just over a year. I’ve had to get used to working in clinic and running my own clinic. This has meant having a new routine and getting to know a large group of patients. There is a great feeling of responsibility in the role and so much to learn. I have had to get abreast of the latest myeloma treatments and look at what treatment changes are on the horizon. Working in a different Trust has also meant becoming familiar with local policies and navigating new systems and processes.
There has been a lot of relationship-building, with colleagues as well as patients. They have all had to get used to someone new. I’ve wanted to prove myself, and had moments of self-doubt but have dealt with this by reminding myself I was given the CNS role for a reason. I research anything I don’t know and always go back and give patients an answer. I am honest about my knowledge and abilities and work as a team with my colleagues and know who to go to for help. I have supervision and regular one-on-ones with our matron who has been amazing and provided lots of reassurance. I also work alongside the lymphoma CNS and our support worker, who has been very supportive.
How do you think your role helps patients and colleagues?
Having a named CNS helps patients manage concerns as there is always someone to call or email. I get back to patients within 24 hours and, if I am away, other members of the team will respond. Even if patients have a question about something minor, it needs answering promptly because small things can still take over a patient’s day. It’s also important for patients who are seen infrequently, such as those with MGUS, to have an effective relationship with their CNS. Patients need to know who they saw or spoke to and not feel lost in the system. I can also prioritise things to help patients most in need of support; for example, helping get medications to those who struggle to get to the pharmacy or prioritising patients who feel unwell. And I can advocate for patients who may feel less able to speak up about their wishes.
Within the hospital and Trust my role includes education of other members of staff. We held a Fundamentals of Cancer course within the Trust, where I presented a session on myeloma. I’ve also given training sessions on the ward and provide a lot of day-to-day education individually to staff, explaining aspects of treatment and care. For example, explaining the significance of tests related to a particular patient. I love this aspect of my role, passing knowledge on to others. It helps staff develop their experience and ultimately helps succession planning.
How would you like to develop your role going forward?
Having recently became a nurse prescriber, I plan to build this new qualification into my role. Fortunately, my CNS colleague is an experienced prescriber so I can go to her for guidance and advice. I plan to start a prescribing clinic later in the year for myeloma patients on maintenance treatment. This will help take pressure off the myeloma clinic and will utilise and embed my new skills. I also plan to do the Sage and Thyme course, which will help further my communication skills in supporting patients who have concerns or are in distress.
What advice would you have for a nurse new to a CNS role?
Trust yourself, trust your knowledge. But having self-doubt is ok as reflecting and checking is part of what makes a good nurse. You shouldn’t give information unless you are 100% sure; you don’t want to let patients down. It’s ok to look things up. Let research be your best friend.
Also remember that patients and other staff may take time to trust you, especially if they have been used to seeing other members of the team. Don’t take this to heart, it’s not a criticism and trust and rapport take time to build. Have broad shoulders and build patience. Patients are people and not their disease. When you first meet patients, if you remember something about them as a person, for example their family, job, or something else important to them, it helps them feel treated as an individual, shows you care and this in turn helps build trust.
The job can be stressful, so be aware of this and look after your own wellbeing. Sitting down and talking through difficult situations is a good way of de-escalating stress. It’s important to be able to step away from the stress and take some time out when you need to. As a team we make sure we find moments to focus on other things, find fun, and talk about what we like and do outside of work.
Q &A with Tela Jiawook-Brooks
Haematology CNS
St Richard’s Hospital, Sussex University Hospitals NHS Foundation Trust