Taking a Stand for the Rheumatology Nurse

Recently, my Google Alert set for “rheumatology nursing” notified me of a curious short article out of Ireland. As we know, tragic, sensational, and even “fake news” often tops the priority list of newsfeeds instead of heartwarming, positive, and inspiring news stories and events that perhaps make us feel a little bit better about ourselves and our chosen line of work. This little story that popped up was one of those that may otherwise have gotten lost were it not for my targeted alert setting. I’m glad I didn’t miss it.

The article began by replaying events from prior years, starting in 2013, when Dr. Muhammad Haroon was appointed as a rheumatologist at University Hospital Kerry (UHK), a facility located in an underserved geographic area of Ireland.1 According to a tweet from one of Dr. Haroon’s patients, it took a year on a waiting list before she was able to have her first visit in the rheumatology clinic at UHK with Dr. Haroon.2

By all accounts, Dr. Haroon is a skilled and well‑liked physician who is highly valued within the community. However, Dr. Haroon had been literally a one-man show throughout the initial years of his tenure at UHK as his rheumatology clinic consisted of just himself with no nursing support.

The crux of the article I read then skipped forward a few years to 2016, when Dr. Haroon asked for the addition and appointment of a Rheumatology Advanced Nurse Practitioner (ANP) to help the backlog of patients trying to get an appointment at UHK. He even had an experienced rheumatology ANP candidate in mind for that position, who he recommended.1 However, the candidate was told that the Health Service Executive—the agency responsible for public funds going to health and social services in Ireland that is headed by the Irish Minister of Health3—had determined that this candidate would be required to accept a reduced grade position from her current assignment as an ANP, as well as a cut in pay. Understandably, she turned down the offer.4

While the story could have ended there. Dr. Haroon took the bold step of petitioning on behalf of the ANP candidate, going so far as to apparently tender his resignation due to the lack of support for rheumatology services at UHK.1,4 According to one news article, the Rheumatology Unit at UHK was the only one in all of Ireland not staffed with an ANP or any other medical assistant.1

After news of Dr. Haroon’s resignation was brought to light, Arthritis Ireland joined him in his petition to support the appropriate title and pay for an ANP.5 Earlier this year, Dr. Haroon and Arthritis Ireland saw some positive movement when UHK was able to bring on a clinic nurse manager, approve the ANP position, and retain Dr. Haroon as the rheumatologist.4 Kudos to Dr. Haroon, Arthritis Ireland, and the ANP in question for standing their ground on this professional and community service issue.

This story, however, is not one that was neatly wrapped in a bow. Due to the amount of time it took to resolve the issues, the experienced ANP who initially was ready to accept the post at UHK took another position in another part of Ireland. UHK did indeed hire a clinic nurse manager to help Dr. Haroon, but this individual was inexperienced in rheumatology and will need to acquire the training necessary to be accredited as a clinic nurse specialist. As we all know, this takes time and experience. We certainly are empathetic to the new experiences she will be faced with as she learns about the complex diseases and treatment options we all encounter every day. Hopefully, this new experience will enrich and assist her career as a rheumatology nurse.

Nurses are among the unsung heroes in healthcare. We are always adapting to a myriad of changes, often seemingly without effort. Nurses are flexible and adaptable and can quite literally fix just about anything with a pair of hemostats and bandage tape (right?). Our ability to adjust and adapt is a career trait that is always assumed but not clearly identified as essential.

This short news blurb from Ireland in the international news superhighway has great significance for rheumatology nurses, providing evidence for the value of the nurse in practice. Here was a rheumatologist willing to resign his post not only because he wasn’t able to bring on a rheumatology nurse in his practice, but because the candidate he thought best was not going to be recognized for the grade and pay equivalent to her education and experience.

The rheumatology nurse is an essential team member in rheumatology care not only from a pharmacologic perspective (eg, delivery of infusion treatments, monitoring for side effects, obtaining blood samples for treatment monitoring) but also from a non‑pharmacologic care perspective. In a systematic review, Ndosi and colleagues noted significant positive effects of nurse-led care on quality of life and other outcomes in patient self-management, knowledge, and satisfaction.6 Furthermore, Kuninkaammiemi and colleagues reported individual counselling/education sessions for as little as 15 minutes over 2-3 routine follow-up visits can show measured changes in patients’ nutritional indices, activity levels, and mobility scales, as well as numerous satisfaction/quality of life improvements.7

Today’s nurses are responsible for much more than just acute care protocols and fundamental tasks. Nurses identify risk factors and apply preventive measures. That is why you are advancing your knowledge by reading this publication. We are all key to a successful patient-centered collaborative care model. Fundamental improvements in patient outcomes can be attained when you build your educational portfolio and become more empowered as a true nursing professional. Just look at the literature for the evidence… and ask for Dr. Haroon’s opinion if you ever meet him.

Sheree Carter HeadshotAUTHOR PROFILE:
Sheree C. Carter, PhD, RN, RN-BC, is an Assistant Professor at The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, and former President of the Rheumatology Nurses Society.

 

 

Reference
1. The Kerryman. Rheumatology row rumbles on at UHK. Available at www.independent.ie/regionals/kerryman/news/rheumatology-row-rumbles-on-at-uhk-35065303.html. Accessed February 21, 2017.
2. Twitter. Available at twitter.com/C_Musings/status/773856157303701504. Accessed February 21, 2017.
3. Wikipedia. Health service executive. Available at en.wikipedia.org/wiki/Health_Service_Executive. Accessed February 21, 2017.
4. The Kerryman. Rheumatology row is resolved at UHK. Available at http://www.independent.ie/regionals/kerryman/news/rheumatology-row-is-resolved-at-uhk-35432755.html. Accessed February 21, 2017.
5. Arthritis Ireland. Available at www.arthritisireland.ie. Accessed February 21, 2017.
6. Ndosi M, Vinall K, Hale C, Bird H, Hill J. The effectiveness of nurse-led care in people with rheumatoid arthritis: A systematic review. Int J Nurs Stud. 2011;48(5):642-654.
7. Kuninkaanniemi H, Villberg J, Vanhala M, Poskiparta M. Behaviour-change interventions in primary care: influence on nutrition and on the metabolic syndrome definers. Int J Nurs Pract. 2011;17(5):470-477.