The past two decades have seen a significant change in oncology nursing. What began as a generalised aspect of nursing, caring for the basic needs of patients with cancer, has become a highly specialised area of nursing practice. It has a defined knowledge and skill base and is supported by expert practice and research (Haylock, 2008).
Cancer care has continued to develop rapidly, not only with regard to treatments, but also with a desire to provide continuity of care for patients (Haylock, 2011). The role of oncology nurses has evolved from a fundamentally task-oriented care role to become an integral element of the cancer care team, serving as liaison between physicians and other disciplines (Haylock, 2011). The NHS Cancer Plan formalised the multidisciplinary team, with cancer nurses as key members, advocating the concept that specialist oncology medical teams should be supported by specialist oncology nurses (Department of Health, 2000). Alongside this change in role came the introduction of societies for the support of nurses and the sharing of knowledge across the world.
Both the International Society of Nurses in Cancer Care (ISNCC) and the European Oncology Nursing Society (EONS) were formed in 1984. The UK Oncology Nursing Society (UKONS) was created in 2005. The goal of these societies is to ensure that all cancer patients are cared for by highly educated, well-informed, and competent cancer nurses, and to promote excellence of care for those directly and indirectly affected by cancer (UKONS, 2018; EONS, 2022).
The rising prevalence of cancer
Cancer is becoming ever more prevalent but, in turn, cancer treatments are improving, resulting in more people surviving or living longer with cancer. Current statistics show that around 375 000 new cancers are diagnosed in the UK each year, but half of the people diagnosed with cancer survive their disease for 10 years or more (Cancer Research UK, 2022). The number of people living with cancer in the UK is set to rise to 4 million by 2030 (Macmillan Cancer Support, 2022).
Increased cancer prevalence has expanded the nursing workload and, as a result, there has been the positive development of the role and remit of the oncology nurse, from specialist nurses to advanced practice roles. Roles now also encompass the need for personalised care assessment and planning to support pre-habilitation and holistic needs assessments, as well as self-management and stratified follow-up to ensure patient-centred care is delivered (Henry, 2015). However, these factors have resulted in the increased incidence of burnout and compassion fatigue as nurses endeavour to meet the emotional demands of their role, as well as to work with limited resources due to staff shortages, acuity and workload (Ko and Kiser-Larson, 2016).
Inevitably, as the incidence of cancer rises and the lifespan of those affected by cancer lengthens, the nursing workforce will need to increase in response to meet patient demand (Oncology Nursing Society, 2015). Modelling shows that the NHS needs thousands more specialist cancer nurses to meet projected patient need (Macmillan Cancer Support, 2021). Macmillan Cancer Support has called on the government to build a robust plan to grow this specialist NHS workforce, demonstrating a need for an additional 4000 cancer nurses by 2030 (Macmillan Cancer Support, 2021).
The House of Commons Health and Social Care Committee (2022) found that a 100% increase over current numbers of specialist cancer nurses is needed. A clear strategy is required to recruit, train and retain the cancer workforce for the future, otherwise patients will have fewer skilled nurses at a time of increasing survivorship and newer, more complex treatments. As a result, there has been an increased focus on supporting young and early career cancer nurses (YECCNs) to ensure the growth of the future workforce and the number of nurses newly qualified or within their first 5 years of nursing choosing to work in oncology.
Young and Early Career Cancer Nurses
In England, the specialist cancer nursing workforce is ageing, with 37% over the age of 50 years in 2017; this has increased from 33% in the 2014 Macmillan census and raises significant concerns regarding the future of the specialist cancer workforce (Macmillan Cancer Support, 2017). This suggests that, within 10 years, one third of specialist nurses will have retired, leaving a large gap in the workforce but also a huge loss of knowledge and experience (Macmillan Cancer Support, 2017). Conversely, only 17% of chemotherapy nurses were older than 50 years, suggesting that there are barriers to progressing to more specialist roles (Macmillan Cancer Support, 2017). It is difficult to see how this skill gap could be filled, especially when compounded by the effects of the pandemic (Macmillan Cancer Support, 2020). It is therefore vital that succession planning becomes an essential part of workforce development to ensure that the workforce continues to grow as needed (Foulkes, 2018). In recent years, as a result, there has been an increased awareness regarding the need to support YECCNs.
Appreciation is needed that the path to being a specialist cancer nurse is becoming increasingly complex and requires autonomous skills, competencies and experience across clinical, leadership and management workstreams (National Cancer Action Team, 2010). This, coupled with the emotional and psychological burden of oncology nursing and, in some areas, poor access to resources and training, means that staff retention in oncology is often difficult (Challinor et al, 2020).
To address these workforce concerns, in Autumn 2021, Health Education England (HEE), in collaboration with Macmillan Cancer Support, UKONS and the Royal College of Nursing, commenced the Aspirate Cancer Career and Education Development programme (ACCEnD). This aims to provide:
‘Guidance and direction of the knowledge, skills and capabilities required by all nurses and allied health professionals who care for people affected by cancer … across the four UK nations.’
The programme seeks to address and provide solutions to key issues that challenge the cancer workforce both now and in the future (HEE, 2022). It is promising to see that the urgent need to define the route for a career in cancer nursing is in development, along with a competency skills framework for clinical nurse specialists and a clear pathway from pre-registration to consultant, and strategic leadership to support succession planning. There is an increase in the number of young nurses entering the nursing workforce in specialist areas, such as cancer care, and it is crucial that they receive the training and support required to provide quality patient care (HEE, 2017).
By defining this group of nurses, the differences and challenges for this cohort can be acknowledged and a better perspective of their needs can be gained (Challinor et al, 2020). By understanding this, it is possible to provide further support and guidance to safeguard the future of cancer nursing. To nurture the next generation of cancer nurses, they should be clearly identified and brought together to empower them as nurse leaders and practitioners.
In this vein, YECCN networks have been created by national and continental oncology societies to create a system of support and education led by YECCNs, but supported by the structure and knowledge of the societies. This has helped to develop awareness and gain momentum for the work of YECCNs. By providing education, support and progression through the creation of YECCN networks within these societies, a continued drive for the exemplary standards of knowledge and care is ensured. As the future leaders in oncology nursing, these nurses need to be supported to enable the continued progression of cancer nursing as a whole, but also to ensure that patients across the nation have access to the same level and quality of care (Sheldon et al, 2016).
This article explores the work of the UKONS YECCN representatives to date. Through sharing the learning and experiences of the YECCN representatives, it is hoped that it will provide some guidance for colleagues who are leading or planning similar projects and to raise awareness among UKONS members to join the YECCN network and support its activities.
Building the UKONS YECCN Network
In 2018, UKONS appointed its first YECCN representative to lead the development of a national network. Owing to the enormity of the task, this has now grown to three YECCN representatives, a model subsequently adopted within EONS.
The key task of the representatives has been to build a YECCN network in the UK and drive the development of the YECCN agenda, with the support of UKONS. These responsibilities are ever growing as the network continues to evolve. The aim is to adapt in light of the changing needs of the YECCN workforce, to listen to peers and to explore how best to meet their needs as a collective.
Oncology nurses make important decisions for their patients each day, advocating for the best possible care and support. But it can be challenging when it comes to personal development, as one of the biggest barriers is often a lack of awareness of where to get support and whom to ask. During the early development of the network, it was realised that, if platforms and opportunities were provided where information could be discussed freely between peers from across the four nations, then learning could be actively shared and leaders of the future developed.
The first YECCN study day took place in June 2019. The topic was ‘Developing your role as a cancer nurse’ and was held in collaboration with Guy's Cancer Academy. This event saw the attendance of YECCNs from across England and Northern Ireland and laid the foundations for what was to come. From here an initial understanding was gained of the priorities of this group and work began to build the YECCN network. The YECCN Facebook group was created, which enabled increased reach to YECCNs across the country. It offers a virtual platform for sharing information and resources and collaborative working to ensure that the needs of the group are being met.
The second YECCN educational event took place in September 2020 and, due to the COVID-19 pandemic, this was a virtual event, hosted by the Royal Marsden School. The success was seen in the registration of 155 cancer nurses and leaders and the exceptional feedback received. The event focused on the events of 2020, exploring the pandemic as well as presenting new initiatives to promote and progress cancer nurses.
Most recently, in October 2021, a virtual educational event was organised in collaboration with the Christie School of Oncology around the theme ‘Connecting with the future’. Speakers covered topics, such as the evolving clinical nurse specialist role and emerging treatments such as chimeric antigen receptors T-cell therapy (CAR-T), and how genetics and genomics will shape cancer care in future. A lively and informative panel discussion regarding ‘The future of young cancer nursing’ also took place. All attendees enjoyed the variety of topics covered, as well as the opportunity to network.
Since 2020, the YECCN representatives have joined UKONS board members to facilitate sessions and support conference speakers at the annual conference. In 2021, each YECCN representative chaired poster discussions with a UKONS board member—an opportunity to develop presentation skills and raise their profile. There is now an annual award for the best YECCN poster.
Since the beginning, UKONS has highly valued the work carried out by the YECCN representatives and truly understood the need to give YECCNs a voice, to ensure they are involved in decisions impacting the future of the cancer workforce. As a result, since inception, the YECCN representatives have had a defined presence within UKONS, sitting on the board as co-opted members and leading on the YECCN agenda for the organisation. In December 2021, a YECCN was successfully elected to the board and now the network forms a recognised member interest group (MIG) within UKONS, with a specific budget to further the YECCN agenda and support their development through educational opportunities.
Membership of the network has risen rapidly since 2019 and now there are 233 members from across the UK involved in the YECCN Facebook group (correct as of March 2022), in comparison to just 34 in January 2020. This shows how necessary the work of the network is, but with the appreciation that there is still a long way to go to ensure that all YECCNs are aware of the network and the support that is available.
Reflections on the experience
The past few years have been an exciting and interesting journey, for UKONS and the YECCN network, but also for the representatives as individuals. The knowledge and understanding of YECCNs and their needs across the UK and Europe has been broadened, meeting some inspirational people along the way. Oncology nursing is often very challenging, but the reward of improving patient care and helping to support and drive the next generation of nurse leaders is the motivator to continue to grow the UKONS YECCN network and support colleagues.
It is hoped that sharing the experiences of the network can encourage others to be part of this ever-growing specialty. Equally, the successes of the UKONS YECCN network show that every country in the world should be strongly encouraged to develop its own network for the benefit of this cohort. As a result, the following suggestions, based on lessons learnt, may be of interest to others looking to develop a network:
- Find an organisation that supports your aims and, in terms of early career nurses, one that keen to safeguard the future of the profession
- One size does not fit all—this article sets out what has worked for us, but every organisation/country may be different, and the approach may need to be adapted. Use our ideas to grow in your own right
- Build relationships—there will always be people who will share in your passion
- Use social media—Twitter, Facebook and LinkedIn can be useful for meeting like-minded people, getting the word out and creating a national platform.
The future
Looking to the future, the UKONS YECCN Network aims to continue to support those who are developing as cancer nurses of the future. The recent appointment of a young cancer nurse to the UKONS board shows the organisation's commitment to ensuring that YECCN needs are at the forefront of decision making across the organisation and the representatives will continue to work to embed YECCNs.
The YECCN representatives aim to continue to offer educational events as well as networking opportunities as pandemic restrictions are lifted. Linking with other organisations is vital to this vision, and it is very much hoped that this will enable the development of events that are relevant to different cohorts within the network, such as nurses from ethnic minority backgrounds.
Currently the YECCN representatives are looking to begin to collate a YECCN database to enable formal governance, opportunities and mentorship across the network involving the UKONS Champions, a group of highly experienced cancer nurses with a huge variety of skill sets. Aligning the work of the YECCN network to current priorities in cancer care continues to be an important directive and working with HEE, Macmillan and the ACCEnD project is fundamental to this. Using social media platforms and moving with the digital age of the NHS is also recognised as an effective way to promote the work of the network and develop across professional boundaries.
Conclusion
The development and success of the UKONS YECCN Network shows what can be achieved by supporting those at the beginning of a specialised career in nursing. The network is grateful for the support of the UKONS Board, in particular Mary Tanay, Verna Lavender and Mark Foulkes, for encouraging its development. Cancer nursing continues to offer a deeply rewarding career, but ongoing pressure to ensure support, CPD opportunities and the funding of positions to maintain a high quality of cancer nursing in the future is essential.
Anyone keen to join the UKONS YECCN Network can do so via Facebook (https://www.facebook.com/groups/406610000062662) or on the UKONS website (https://www.ukons.org/ukons-young-early-career-cancer-nurses-network).