During the start of the first COVID lockdown, a friend of mine enticed me to join their team, into a speciality that I’ve never thought I’ll ever be doing in my entire nursing career: Oncology & Haematology Nursing.
I'm Neil, a Ph-licensed nurse since 2012, and a UKRN working for the NHS sector since 2018. I have spent most of my nursing practice in the perioperative environment mainly in the Operating Theatres with exposure to PACU and sterile supply department. I've also held management roles in Riyadh, Saudi Arabia for three years before setting my foot in East Sussex, England. I was assigned to the Acute Medical Unit briefly and have decided to move to Theatre Nursing and finally to be an Onco-Haema Nurse. As I jumped to a completely different new role, I must say it was challenging but at the same time a very rewarding career leap.
To give you a little bit of background, a nurse who works in an 'Onco-Haema' or ‘Chemo Unit’ in the UK nowadays basically needs to be a Systemic Anti-Cancer Therapy (SACT) Passport holder to prove their competency, as required by the UK Oncology Nursing Society (UKONS). Regardless if you already have previous background on chemotherapy administration outside the UK or completely novice to this speciality, any qualified nurse who is about to hold SACT roles needs to accomplish the passport which is basically aimed to standardise theoretical knowledge & competency of SACT nurses across the UK.There is no specific time frame in accomplishing the passport, but ideally within a year. In essence, this competency can be your ‘passport’ in administering SACT wherever in the UK.
The job in a chemotherapy unit does not just revolve around administering SACT. We are trained to do pre-SACT information sessions, central line care, medical infusions, PICC line insertions, and the list goes on. Each day, our unit has one nurse coordinator assigned (mostly Band 6 or Band 7 Matron), who is in charge of the unit’s workflow management on top of triaging calls and referrals, liaising with consultants and other nurse specialists, authorization of SACT prescriptions which involves interpreting blood results with pre-SACT assessments.
Having no doctors around in a nurse-led unit, nursing assessment is a crucial part of our daily job. Ideally, we keep patients on their SACT regimen as continuous and, likewise, as safe as possible. Anything that would prompt us that the therapy is toxic for them should be intervened: may it be with further investigation, a delay of treatment and/or a dose reduction. A keen clinical eye is essential to decipher when not to give SACT as it can be fatal if a key information or dilemma is missed.
On the psychological side of things, we also ensure that patients’ anxieties or concerns are addressed and there’s an intact support for them as well as their families since cancer itself can be quite daunting and overwhelming. Likewise, in terms of administering vesicant drugs, excellent cannulation & venepuncture skills is no doubt fundamental in a chemotherapy unit-- a skill that I believe we, Filipino nurses, are widely known to excel at!
Cannula insertion skill is highly imperative in this role as it does affect patient comfort and safety. Many of SACT substances are given intravenously and as the therapy progresses, the health & patency of veins gets affected. As for me, I fortunately managed to enhance my cannulation skills in less than a year. I eventually got the privilege to be trained in inserting PICC lines in our day unit. Interestingly, the slope of the learning curve and career progression in this area of speciality can be quite steep and pace can be quick at some point. It depends not just on how much support you get from your colleagues and seniors, or how spongy your brain is when absorbing information, but more importantly on how you deal and navigate with your mistakes—each failed attempt still counts and gets charged to your experience baggage. Up until now, I keep track of my successful & failed attempts on PICC line insertion, what went wrong & how it went right.
Obviously, as with any other role in nursing, having merely a clinical eye and skilful hands do not suffice; therapeutic communication also plays a very huge part in this area of speciality. For certain, it takes time for one to learn how to handle tender conversations in this role, where topics on a day-to-day basis can range from being trivial down to being grim, particularly when learning about the “bad news.”
The realities of the lives of “people affected by cancer” (PABC) can be enriching when focused on the positive side, for sure. It’s utterly saddening though that there's still this massive false connotation that dealing with PABC is absolutely depressing or upsetting, at the very least. Surely, anyone who works in a cancer unit almost always gets an immediate answer of "Oh, isn't that depressing?" whenever people learn of where they work. Ironically, I realised that the chemotherapy day unit must’ve been the most positive area in terms of atmosphere in the hospital I’ve been and worked into. It’s not because of forced optimism or false reassurances, but because it’s just how it is. It is embedded with humour despite apparent pain, with laughter despite difficult uncertainties. Most of all, you get to work with colleagues & staff who are so compassionate & passionate about the job—it is just so contagious!
The very nature of working in the healthcare industry (not being limited to Oncology Nursing but in general) can be truly upsetting - in its context of illnesses, the subsequent effects of being ill to people’s lives and the inevitability of mortality. This may be a sad truth that we face as health practitioners, but on the flip side, we help them to get back on their feet and foster hope to improve their lives after the treatment regimen. I firmly believe it all boils down to one’s perspective and how you turn things around to make the job fulfilling at the end of a gruelling and sometimes tear-jerking day.
Just nineteen months since I began giving SACT and honestly, I still have to ascertain which area I’m going to further specialise in. There’s the common path of becoming a Clinical Nurse Specialist (CNS), or an Acute Oncology Nurse Specialist (AONS); a Clinical Research Nurse, or perhaps a Vascular Access Specialist. Who knows? The list is so vast and opportunities in this area are indeed aplenty. The world of Onco-Haema is extremely fascinating with all these ground-breaking plethora of treatments & procedures being developed.
Despite just recently attaining a Band 6 role, I still somehow consider myself as a novice everyday, always leaving plenty of space in my brain for new learnings. Nursing can definitely be exhausting and it will drain you in every aspect you can think of. Thus, my piece of advice for those who would want to venture into the speciality of Oncology & Haematology is to go and apply for it as it will all be worth the effort. But, always make sure you have at least a few interests or hobbies outside of work for self-care, to cope and to destress, and a firm support system to keep you sane and centred. Truism as it may sound but health is wealth. Nevertheless, being an Onco-Haema Nurse may be a stressful role at a glance but I assure you, with the right knowledge and skills, it is impactful and rewarding as you help patients fight and thrive against a life-changing disease.