Empowerment or Deskilling? An Evaluation of the Impact of the Hospital Palliative Care Clinical Nurse Specialist on Doctors and Nurses

Background: Palliative and cancer care have one of the largest numbers of Clinical Nurse Specialists (CNS) of any specialty, which has escalated following the recommendations of the NHS Cancer Plan of Health (Department of Health 2000) particularly in the hospital setting. However there is limited evidence of the effectiveness of CNS on patients and additionally upon hospital medical and nursing staff. Although studies have suggested benefits for both doctors and nurses of having CNS in post, more recently the potential of the de-skilling of staff is being raised (Castledine, 2000; Jack et al, 2002) With the current policy emphasis on demonstrable clinical effectiveness, there is an urgent need to establish the value of CNS in the area of palliative and cancer care. Method: This paper presents the qualitative findings of an evaluation study on the impact of the CNS within a palliative care team in an acute UK hospital. A stakeholder evaluation using 31 tape-recorded semi-structured interviews with stakeholders across the hospital setting including; senior nurses, consultants, junior doctors and nurses representing the different grades, explored how they saw the impact of the palliative care CNS. The data was analysed for emerging themes using case and cross case analysis. Results and Discussion: One theme that emerged was the potential of the CNS de-skilling doctors and nurses. Senior stakeholders and the palliative care team identified this issue, whereas the junior staff did not perceive it. The results will be discussed and potential explanations suggested, including whether the CNS are actually empowering rather than deskilling doctors and nurses. Intended learning outcomes: • Have an awareness of the expansion of CNS in palliative and cancer care • Be aware of the need to evaluate the impact of the palliative care CNS • Appreciate the potential benefits and disadvantages that CNS can have.