The prevalence of pleural disease is increasing, and more patients are requiring intervention to investigate and manage pleural effusions. This pathway has often been prolonged, with patients frequently encountering significant delays in both getting a diagnosis for the cause of the effusion and then receiving an intervention for symptomatic relief. These delays are often due to the availability of medics trained to perform pleural procedures such as diagnostic and therapeutic aspirations and inserting chest drains.
A dedicated pleural team was needed and the Trust's respiratory team thought that having a dedicated nurse specialist for pleural disease, who could be trained to perform these procedures, would improve the patient experience and care by reducing waiting times for procedures.
Over the past 4 years I have worked closely with my consultant colleagues to build knowledge and skills in pleural disease management. There were many challenges to overcome in the early days, not least that this was traditionally a subspecialty dominated by medics with little input from nurses.
As I would be the first nurse in the Trust to undertake these procedures, there were no nursing competencies to work through, so it was decided that my training should mimic that of the medical registrars, with a longer period of supervised practice.
‘Acquiring these skills has enabled me to improve the pathway for patients with pleural effusions by affording them faster access to both diagnostic and therapeutic interventions’
I began by sitting in on pleural clinics and observing the consultant perform thoracic ultrasounds. The first challenge was to gain level 1 competency in thoracic ultrasound. This took many hours in clinics and on the wards, working with the respiratory consultants and registrars. Once I had met a certain standard of practice, I was able to start performing pleural procedures, beginning with diagnostic and therapeutic aspirations, under supervision. This was a nerve-wracking experience but also a very rewarding one and I felt a great sense of accomplishment when I was then able to perform these procedures independently and was subsequently signed off as competent in level 1 ultrasound. I have since also been judged competent to insert chest drains for patients with a pleural effusion.
Acquiring these skills has enabled me to improve the pathway for patients with pleural effusions by affording them faster access to both diagnostic and therapeutic interventions. In my role as the pleural nurse practitioner I have worked hard to be a resource and a contact for patients undergoing investigation and treatment in order to make their journey as smooth as possible.
I have fostered a close working relationship with our lung cancer multidisciplinary team and now take direct referrals from their clinics to aid in the diagnosis of suspected lung cancer or to provide symptomatic relief to a patient with a pleural effusion. I also refer patients with suspected lung cancer who have been referred to the pleural service from elsewhere in the hospital to the lung cancer team. In this way they can be tracked by the team to ensure that they do not fall through the cracks and are taken through the diagnostic pathway as efficiently as possible.
I was pleased to be nominated and to achieve a runner-up award in the BJN Awards 2020 Respiratory Nurse of the Year category for this work.