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The role of the clinical nurse specialist in clinical immunology

When I started in my role as a clinical nurse specialist (CNS) for allergy and clinical immunology, I was not sure what the role would entail. I did a literature search and relied on my colleagues, who were already in such a position. Now, 15 years later, there is still no fixed definition for the role, probably because the role of the CNS is different depending on the specialty you work in.

However, in general “CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge”.1 Furthermore, in immunology nursing, we care for patients with chronic conditions such as primary antibody deficiency and hereditary angio-oedema. Supporting the relationship between the patient and their clinicians is important in helping to provide the best possible care. Peter Vickers highlighted this in 2008: “Nurse specialists in immunology prescribe, administer immunoglobulin, train patients for home therapy and support them in all aspects of the care pathway. They also assist the partnerships between healthcare professionals, patients and their family.”2

As a clinical nurse specialist, you are the link between the patient and the doctor, and very often, the voice of the patient, as well as their advocate.

So, what is the role of the nurse specialist in immunology? One of the main roles in immunology is the home therapy training programme. The nurses are involved in the decision of whether a patient is suitable for home therapy; they have a consultation to decide upon the route and frequency of therapy that leads to the best possible outcome. After this, the training is carried out and the patient has a home visit to ensure that the training has been successful and the home environment is suitable. A yearly risk assessment is then performed where the CNS observes the patient performing an infusion, to ensure no ‘bad habits’ have developed. Most clinical nurse specialists are involved in research co-ordination and undertaking of the same. Clinical nurse specialists also participate in medical research trials, either regarding medication or trials to help with diagnosis, especially in the age of genetic diagnosis.

As a clinical nurse specialist, you are the link between the patient and the doctor, and very often, the voice of the patient, as well as their advocate. We also help with relaying clinical information in a way that the patient is able to understand, and write leaflets to help with this. A lot of nurse specialists can prescribe relevant medication and have nurse-led clinics to relieve some pressure from the doctors’ clinics. We, therefore, can save money for the NHS. Nurse specialists, have a telephone support service and patients can contact us via email; very often as the first point of contact for any questions or advice. Clinical nurse specialists also very often lead on transitional care and see the patients before they come to the adult service to help with a smooth transition. So, all in all, we coordinate all aspects of the care of the patient and anything that relates to the wider community. We can refer patients to other healthcare professionals, for example, physiotherapists, if required.

However, to be able to provide this service, a clinical nurse specialist first needs to develop specialist knowledge and experience. Most clinical nurse specialists have either a degree or an MSc within their speciality or in general medicine. For allergy, there are some courses that are aimed at healthcare professionals; however, in immunology it is a bit more difficult. There was a MSc degree for immunology nursing, but that was discontinued and at the moment there are no immunology courses available aimed at nurses. Therefore, a lot of nurses complete an MSc in related specialities – such as research or allergy – or, in advanced nursing practice. There are some online courses on the INGID (International Nurses Group for Immunodeficiences) website.

Dorothea Grosse-Kreul Senior Specialist Nurse for Allergy and Clinical Immunology,  King’s College Hospital NHS Foundation Trust

Sarita Workman Specialist Sister in Immunology Research, Royal Free Hospital NHS Foundation Trust

 

REFERENCES

  1. Mayo et al. 2017 Nursing Administration Quarterly 41 70–76
  2. Vickers, P 2008 Severe combined immunodeficiency early hospitalisation and isolation Wiley-Blackwell, Oxford, UK