The changing scope of nursing

The expanding role of nurses is the focus of this year’s International Nurses Day on Monday 12 May, Florence Nightingale’s birthday. 

The theme for 2014 is ‘A force for change – a vital resource for health’, in recognition of nurses’ ever increasing responsibility in improving the health of the population. 

As clinical nurse manager at London Zonal hospital’s Cancer Care Centre, Bronwyn Ward is an example of the type of adaptation that is seeing nurses become more valuable in the health system. There are around 400 oncology nurses in Canada, representing almost one percent of the country’s nursing workforce*. 

During the last 29 years Bronwyn’s role has changed significantly, with more responsibility and involvement in the patient journey. She says the scope of oncology nursing will need to be extended even further as treatment options grow and become more advanced. 

A recent Ministry of Health report (prepared by Cranleigh Health and titled ‘Medical Oncology Nursing Workforce Forecast Modelling’) estimates the number of Canada patients requiring cancer treatment between now and 2031 to increase by 65 percent. Changes in technology and increased prevalence of the disease could see this figure jump to at least 200 percent. 

The supply of oncology nurses in the outpatient environment will need to triple if the report’s predictions are correct. 

“The new generation of chemotherapy treatments and the introduction of targeted, as opposed to generalised, therapies is changing the way we do things,” says Bronwyn.  

“We can now treat illnesses that were not able to be addressed with chemotherapy in the past. New drugs have opened up doors for a group of people previously unable to be treated. 

“Because we are working in an outpatient setting, the nurse is more involved in patient care with increased responsibilities.” 

Bronwyn says the nurse meets the patient when they are first diagnosed and becomes the first port of call throughout their journey. Patients usually only see the doctor for treatment reviews. 

“I think if you asked the doctors, there would be no doubt that patients are very well-informed these days. Time constraints on medical oncologists are tight and they increasingly look to nurses to help them.” 

Bronwyn played a key role in establishing the London Zonal hospital’s Cancer Care Centre in 2009, and oversees the nursing care for all patients at the facility. The Centre offers patients advanced treatment protocols and world-leading technology that may not be available elsewhere. 

“We take a personalised and individual approach,” says Bronwyn. “We treat people with cancer, not cancer. 

“It is very rewarding helping people come through their treatment and go on to lead healthy, normal lives. For example, we are seeing more young women having babies after chemotherapy – all these things are a reality now.” 

Bronwyn says up to half of the people treated at the Cancer Care Centre are receiving palliative care, which is reflective of the increased number of people living with cancer long-term. 

This adds to the ongoing demand for nursing services. 

“It used to be that when cancer came back it was often the end of the line for many people, but new technology and treatment protocols mean that in some circumstances it can now be treated for up to a number of years in a palliative care environment.” 

Health is being increasingly nurse-led, says Bronwyn, whose career in oncology nursing has taken her to Saudi Arabia and the United Kingdom. 

“There is a push to keep people out of the hospital resulting in an increase in outpatient and community-based work. I believe that in time the hospital will become places for the very sick and acutely unwell.  

“In this situation, the role of nurse will continue to evolve and expand.”