Throughout my career I have been passionate about the need for education and support for nurses to develop their skills and knowledge in a supportive environment. In the 30 years I've worked in urology there has been a move to develop nurses' roles by extending their skills, knowledge and practice, allowing them to perform more interventional investigations and procedures previously seen as the remit of medical staff.
In 2000, the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN) published guidelines for the implementation of nurse-run flexible cystoscopy services, with these being updated in 2017 to reflect the expansion in the types and complexities of procedures that nurses were performing (Ellis, 2000). Despite this, there have been only limited accredited postgraduate courses available for nurses and the non-medical workforce within urology.
The NHS Long Term Workforce Plan (NHS England, 2023) highlighted the need for staff with the right skills and competencies to deliver services that provide the best possible care to patients and meet the increasing demand. The urology education programme that I have led is focused on meeting these aims. The Nursing and Midwifery Council Code (2018) states that all nurses should work safely within the limits of their competence, and undertaking master's level education allows the opportunity to develop safe, evidence-based practice.
Establishing the programmes
Mersey and West Lancashire Teaching Hospitals NHS Trust (MWL) and Edge Hill University (EHU) had an established working relationship as student nurses and nursing apprentices had placements at the Trust and this formed part of formal partnerships between the two organisations. MWL was widely recognised as having a large, wellestablished team of specialist urology nurses, including:
They were supported by a dynamic and forward-thinking group of consultant urologists who supported the development of the nursing workforce. It was felt that, as a centre of expertise, the Trust stood in good stead to strengthen the service through more formal partnership arrangements with EHU to develop urology education for nurses and the wider non-medical workforce.
Scoping meetings involving a wide range of key stakeholders including clinicians, manager and service users from the Trust and EHU were held in 2018. Initial agreement was to develop a Postgraduate Certificate in Urology Practice, which consisted of a Foundations for Urology Care module – a 40-credit master's level 7 module running from September to April and a further 20-credit module to complete the award, running from April to September. A close working relationship developed between the senior lecturer at EHU and me and we began the process of developing the Foundations for Urology Care module. For me this was a steep learning curve in terms of developing an accredited academic module and programme regulated by a university and requiring submission to a variety of academic boards for approval.
Moving from a clinical, time-critical specialty as a uro-oncology nurse to developing postgraduate teaching and learning took some adjustment initially. But it proved to be highly rewarding and satisfying when approval for this, and the subsequent modules and programmes we developed, was granted. The modules and programmes were then delivered under a formal partnership agreement between the university and the Trust with clear definitions of the responsibilities of each party in delivering the education provision.
Funding
A funding application was made to Cheshire and Merseyside Cancer Alliance in 2019 and £248000 was received in transformational funding to allow the programmes and modules to be developed. This allowed for me to be seconded on a full-time basis to develop the programme, as well as providing funding for two consultant urologists as clinical lead and deputy clinical lead for the programme to have one session per week to develop the programme. This funding also allowed for the first cohort of 13 students from Merseyside and Cheshire to be funded to undertake the Postgraduate Certificate in Urology Practice. Our work in developing the programme was further strengthened when the Getting It Right First Time (GIRFT) programme published its national report on urology services (Harrison, 2018), highlighting the need for a better career structure for specialist urological nurses, to extend their role and help deliver more treatment in an outpatient setting.
Developing modules and programmes
Following on from successfully establishing the Postgraduate Certificate in Urology Practice, we moved on to developing two clinical modules in local anaesthetic transperineal prostate biopsies (LATP) and flexible cystoscopy. These can be undertaken as either standalone modules or as part of the postgraduate certificate or MSc Urology pathways. This allows experienced urology nurses wishing to expand their clinical practice to undergo accredited education and training in these specialist skills.
The MSc Urology was introduced in September 2022. This programme also has a degree of flexibility as students who have already completed level 7 modules – for example, non-medical prescribing – can apply to have the credits recognised on their MSc Urology pathway via recognition of prior learning (RPL).
Delivery of the modules
The unique feature of the programmes and modules is their delivery, which is by frontline clinicians from across England. Consultant urologists and senior registrars from Merseyside, Cheshire and Manchester chair most of the study days on the Foundations for Urology Care module and speakers are drawn from within their specialist nursing and medical team members.
Students have the option to attend the majority of the postgraduate certificate course virtually. Although setting up the IT initially was an aspect I found particularly challenging, it has allowed students to attend from all over the UK, ensuring the sustainability of the provision.
My role involves organising the study days, ensuring that they run effectively for those attending face to face and virtually, and liaising with the chairs and speakers to ensure that the study days all run smoothly. An important aspect of my role is the ongoing support of the students throughout the modules, particularly for the clinical modules, when challenges in clinical practice can lead to delays in competencies being achieved.
Evaluating the impact of the urology education programme
Evaluating the impact of the students undergoing the modules and programme on their workplaces was seen as vitally important. I received lots of positive verbal feedback on the impact within urology units in terms of, for example, role expansion and increased confidence in practice. Therefore, a formal evaluation was undertaken, initially in the form of an audit, which has subsequently been developed into a research project registered with EHU. In view of the additional work this generated and the growing number of students, a business case was put together for an audit clerk, who joined the team to work alongside me and has allowed us to collect very encouraging data on the effectiveness of the urology education programme.
A questionnaire was sent to students who had completed or were nearing completion of their award or modules, and they were asked about: demographics; confidence and personal development; knowledge, understanding and clinical skills; workforce and service development; and professional development, and, where appropriate, the impact of developing clinical skills on their service. For those students who completed the clinical modules for flexible cystoscopy and LATP:
This reflects not only a cost saving but, more importantly post-COVID-19, has freed up consultant urologists to do more complex work in clinics and theatre. There have also been notable improvements to the students' knowledge, level of confidence, and their ability to contribute to the leadership and development of urology services.
Conclusion
Establishing the urology education programme has been a very rewarding experience, embracing the enthusiasm and ongoing support of those who teach on the all the modules. Supporting the students in achieving their personal goals as well as seeing their passion for urology and their desire to improve the services they provide for their patients is an ongoing motivator for me in terms of developing the programmes further. The process has not been without its challenges, particularly when COVID-19 delayed the first intake of students, but the support that I have received from everyone involved with the programme has made it a very fulfilling and gratifying experience.
I was pleased to be awarded the Gold Award in the Urology Nurse of the Year category of the BJN Awards 2024.