Breast Nurses

All about breast nurses
Many women will say how fortunate they feel to have experienced the help of a Breast Nurse during their breast cancer journeys. They have never forgotten the support, care and companionship they received. These wonderful specialist nurses offered information, advice, clinical expertise, kindness, a shoulder to cry on when needed and were always there to listen.

Breast Nurses work throughout New Zealand within both public and private clinics, supporting women through their diagnosis and treatment for breast cancer. They are specially trained to work alongside our surgeons and oncologists to make breast cancer journeys a little easier to bear.

BCAC was fortunate enough to spend some time recently with Janice Wood, Breast Nurse at the Anne Young Breast Clinic. Our interview with Janice follows these facts about Breast Nurses:

• The concept of a specialist breast nurse originated in the UK with the Macmillan Nurses (specialist nurses for all cancers).  The first breast nurse started work in New Zealand in the late 1970s at Middlemore Hospital.
• There are between 25 and 30 breast nurses working in New Zealand with 14 of those located in Auckland.
• Full time certification courses for specialist breast nurses are offered at La Trobe University in Melbourne. Most breast nurses working in New Zealand have received their accreditation from these courses – the Breast Care Nursing Graduate Certificate and Post Graduate Diploma in Breast Nursing Science. A breast care nursing course is also available at the Waikato Institute of Technology and papers can be completed at Auckland University towards certification.
• The three Breast Nurses working within the Waitemata DHB (two at North Shore and one at Waitakere Hospital) saw some 240 new cases of breast cancer in 2007. They expect to see at least that many in 2008. Waitemata is the largest DHB in New Zealand and serves one of the country’s fastest growing areas.

Janice Wood
Janice Wood, Breast Nurse at North Shore Hospital’s Anne Young Breast Clinic (Auckland), shares her passion with BCAC for a role that supports women through an experience with breast cancer

Janice (pictured at right) always wanted to be a nurse and has never regretted her career choice.

Janice worked in Christchurch after receiving her nursing certification and then travelled to London where she lived for a number of years. Upon returning to New Zealand she worked as a practice nurse in Auckland and felt this experience gave her an excellent foundation for her current role as a breast nurse within a busy public hospital.  “I met so many different people, learned a lot about all kinds of peripheral conditions, knew how to interpret blood test results – all good, useful basic knowledge that I use every day in this role.”

After 5 years as a practice nurse, Janice began work with Auckland breast surgeon Belinda Scott in her practice at Breast Associates. “I’d always had a real interest in women’s health," said Janice. "I didn’t know a lot about breast cancer at the time but was very interested. I thoroughly enjoyed working with Belinda and learned so much.”

Janice worked with Belinda Scott for just over five years and then had a complete vocational change. She took up landscape gardening for three years.

“It was good for me to have that change and after three years I was ready to get the brain going again so when a chance came up to fill in at North Shore Hospital I took it and I love it. It’s a great job – a wonderful role – I meet the most amazing women.”

While Janice enjoyed working in private practice she likes the public arena because it has a different focus.

“We see a wider range of people with so many different circumstances and life stories. I have more direct involvement with oncologists and other medical disciplines in this role too. I work within a very supportive and dedicated team and we are committed to improving the way we do things so we can offer the best possible services to our patients. We’re currently developing a ‘patient co-design project’, seeking input from patients who have been through the system and asking them how they think we can do things better. Patients come up with ideas and issues we may never think of. We are also involved in a wider Breast Service Improvement Project which is looking for efficiencies in the way the service is delivered. It’s all about improving the quality of the breast clinic.”

The Role of the Breast Nurse
Breast nurses inform, support and act as a patient’s advocate when necessary. “We are a woman’s support person right through her whole experience,” said Janice. “We make sure she is totally informed in a way she can really understand. We talk to women about what we’re doing for them and why and try to provide ongoing support. It’s not always possible for them to speak with their medical professionals when they’re worried about something so we want women to know they can phone us at any time.”

Breast nurses are there right from the start. They will attend the consultation where a woman receives the news that she has breast cancer. This is an emotional and traumatic time and breast nurses are there to help. “We offer to take notes for them, discuss the information afterwards, and make sure they know they can call us at any stage. We try to stay involved for the whole journey – diagnosis, surgery, treatment – and also let women know that we can advocate for them if needed, speak on their behalf, ask questions for them or liaise with their surgeons or oncologists. We can also sit in on the first appointment women have with an oncologist where their treatment plan is discussed. This happens at North Shore and treatment is received at the Auckland Oncology Centre. During treatment we work with the Cancer Society Liaison Nurses to ensure women are being looked after and supported.”

Breast nurses perform specialised clinical functions as well. For example, on clinic days they assist with biopsies, care for surgical wounds, drain seromas and expand the tissue expanders in preparation for reconstruction implants. They are trained to provide counselling for women, either face to face or over the phone. They visit women in the wards post-surgery (an overnight stay is usual in public with follow-up care provided at home by district nurse visits) and assist with the discharge process too. “A breast nurse is the last person to see a woman before she leaves hospital," said Janice. "When the team has agreed on discharge, we visit women in the ward and talk about post-operative care, exercise, lymphoedema and also discuss results of biopsies, for example sentinel node. We explain what it all means and how results may affect them. We also talk about upcoming treatment if that is needed – chemotherapy, radiotherapy, hormonal treatments – we go over schedules and appointments, make sure they have all the information they need. We follow up with a phone call a couple days after discharge, just to make sure they’re doing all right at home and to see if they have any questions or concerns.”

Breast nurses have a high degree of independence which is a testament to the value of their special training and expertise. “We do practice independently and manage anything that happens with patients outside of diagnosis and surgery. We run our own clinics, give appointments for women to come see us and we manage their wounds without having to involve the doctors unless it’s something that needs medical input. We attend the multi- disciplinary team meetings so we’re part of that decision-making process as well. We also refer patients on to other disciplines – for example, they may need lymphoedema treatment or physiotherapy.”

The future is bright for Breast Nurses
Janice feels there is scope for Breast Nurse Specialists to become active in ‘nurse led clinics’. “There is quite an issue in public with follow-ups. There are so many to be done. New patients will always have a high priority so we have to look at other ways to manage follow ups. I believe that breast nurses, with specialist training, could manage some of these follow-up appointments in the future. As long as patients are reviewed annually with a mammogram and specialist consultation, other visits during the year can be managed by the GP, oncologists or the Specialist Breast Nurse.”

It has been suggested that the recent de-registration of Breast Physicians may allow Breast Nurses to step into this role. Janice felt this was doubtful in the near future due to the radiology expertise Breast Physicians must have.  

So in the meantime, our Breast Nurses will be there to look after women and walk alongside them as they embark on one of the most difficult journeys of their lives.  

“We are there with women on the day of their diagnosis,” said Janice. “They’re devastated but then we watch them gain strength as they continue through, coping with things they never thought they’d ever have to -  or be able to -  cope with – and they do it! It’s really a privilege to do this job. It’s not just patients and numbers – it’s all about people.”

© BCAC June 2008

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