Breast care nurses are registered nurses who have specialist skills and knowledge about breast care nursing.

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Western Health, a large public health service in metropolitan Melbourne, provides care for an increasing number of breast cancer patients each year.

In 2019 the Western Health Foundation and the Breast Service at Western Health created an annual scholarship for nursing staff to expand and strengthen the capacity of the Breast Service by increasing the effective workforce, providing a funded staff development opportunity, providing support to the existing Breast team including provision of a succession plan and skilled cover for leave, and ensuring ongoing excellence in patient care.

To date, four nurses have been awarded the scholarship and completed the program. The recipients have developed breast care nursing expertise enabling them and the Breast Service at Western Health to provide breast patients with better care and support.

Keywords: Breast care nurse, workforce development, Australia

Key points: A scholarship program is helping registered nurses in Melbourne gain the skills and knowledge they need to become specialist breast care nurses and assist a major public health service to expand and strengthen the capacity of its breast service and ensure high quality care for patients with breast cancer.

Introduction

Breast care nurses are part of a multidisciplinary team, which provides clinical care, support, education, and information for people with breast cancer as well as their families and carers.

Specialist breast care nurses were first introduced in Australia in the mid-1990s.¹ Breast care nurses are registered nurses with specialist knowledge, skills and experience; are often the primary contact and coordinate care for people with breast cancer; and have a positive impact on the quality of patient care. They aim to optimise an individual’s health and wellbeing at various phases across the continuum of breast cancer care including diagnosis, treatment, rehabilitation, follow-up and palliative care.² Breast care nurses are highly valued by patients with breast cancer,^3,4 and patients who have received care and support from a breast care nurse report high levels of satisfaction with the information and support⁵  and care⁶ received, decreased unmet psychosocial and health needs,⁷ and increased self-efficacy⁷ and quality of life.^6,8 People with breast cancer who are well supported during their treatment are more likely to have positive outcomes⁹ and better psychological wellbeing.

Western Health is a large public health service in the western suburbs of Melbourne which provides a multidisciplinary service for over 130 patients who are diagnosed with breast cancer each year. The first breast care nurse was employed at Western Health in 2019 and Western Health’s Breast Service currently employs 1.5FTE breast care nurses and two McGrath metastatic nurses who care for over 180 patients. Many of these patients are newly diagnosed and require ongoing emotional and practical support often outside of normal business hours.

Breast care nurses at Western Health spend time with patients to outline and reiterate diagnosis information, plan treatments after discussion with a medical consultant, and provide written information and links to support networks. The work is highly specialised and requires both clinical expertise and skills as well as the ability to provide emotional care.

The breast care nurses also assume responsibility for many engagement and support activities such as co-management of the Breast Care packs (which are filled with items breast cancer patients find useful including lambs wool seatbelt covers, breast pillows, drain tube bag, mouth care products and head sock), maintaining relationships with suppliers and community supporters and engaging breast care patients in fundraising activities such as the Western Health Foundation’s Night of Nights event.

As result of the high and specialised workload of breast care nurses and the increasing number of breast cancer patients at Western Health, Western Health found it difficult to adequately staff its breast care service. Anecdotal evidence from breast care patients also indicated that they would prefer and appreciate more contact and increased one on one support from their breast care nurse.

In order to ensure an adequate breast care nurse workforce and high-quality care for breast cancer patients, the Western Health Foundation which raises funds to support Western Health and the Western Health Breast Service created an annual scholarship for nursing staff at Western Health. The 12-month scholarship provides ‘on the job’ training and upskilling of a member of the current nursing team about breast care nursing.

The scholarship has been awarded to four nurses since its inception in 2019.

As part of the scholarship, a registered nurse employed at Western Health with at least three years nursing experience is offered a fully funded scholarship to undertake the Graduate Certificate in Cancer Nursing provided by the Australian College of Nursing.¹⁰

The course provides nurses with the principles of breast cancer nursing in order to improve their knowledge and skills for the provision and coordination of evidenced based breast cancer care.¹⁰

The applicant also undertakes a paid two days a week observational placement at Western Health which leads to supervised practise working with a Breast Nurse Consultant over the 12 months of the scholarship. The placement at Western Health includes rotations through different clinical areas including the chemotherapy day unit, radiotherapy, theatre, radiology, and breast clinic as well as exposure to external support services offered at Western Health such as Counterpart and the Otis Foundation.

Participants in the program have reported that it is a valuable experience which has provided them with mentoring, training, and real clinical experience about breast care nursing.

‘A breast cancer journey is unique with many stages. Because of this program, I feel better equipped to talk with patients about what to expect at each stage and provide them with better care and support.’ (Western Health Breast Care Nursing Scholarship recipient)

Breast care clinicians have also identified the importance of the scholarship.

‘The Breast Care Nursing (BCN) team has welcomed the opportunity to mentor the scholarship recipients. The opportunity to share what we do and help expose the recipient to another working environment is invaluable for both the team and the recipient. At the end of the scholarship, we find that the recipient’s confidence has increased as has their ability to adapt to situations. The scholarship also enables the BCN team to have an additional qualified staff member who can assist in leave cover as well as allowing the wards to have access to knowledge around breast care.’ (Western Health Breast Care Nurse Consultant)

The Breast Care Nursing scholarship has had workforce and patient benefits for Western Health including increasing the Breast Service workforce, strengthening its capacity, and providing a succession plan and skilled cover for leave; providing funded staff development opportunities; and ensuring high quality patient care. The scholarship reflects Western Health’s value of, and commitment to, its nursing workforce and their ongoing professional development.

Conclusion

The Western Health Breast Care scholarship appears to be an appropriate, acceptable, and effective way to deliver professional development and training for registered nurses interested in breast care nursing, ensure an adequate and skilled breast care workforce, and provide high-quality psychosocial support and clinical care for breast cancer patients.

References

1. Jones L, Leach L, Chambers S, Occhipinti S. Scope of practice of the breast care nurse: a comparison of health professional perspectives. Eur J Oncol Nurs. 2010;14(4):322-7.

2. National Breast Cancer Centre. Specialist Breast Nurse Competency Standards and Associated Educational Requirements. Camperdown, NSW: National Breast Cancer Centre; 2005.

3. Ahern T, Gardner A, Courtney M. A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer. Nurs Open. 2015;2(2):62-71.

4. Smith AL, Boyle F, Lewis S. Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia. BMC Health Services Research. 2022;22(1):942.

5. Ahern T, Gardner A, Courtney M. Geographical comparisons of information and support needs of Australian women following the primary treatment of breast cancer: a 10-year replication study. Health Expect. 2015;18(6):2678-92.

6. Brown T, Cruickshank S, Noblet M. Specialist breast care nurses for support of women with breast cancer. Cochrane Database of Systematic Reviews. 2021(2).

7. Ahern T, Gardner A, Courtney M. Exploring patient support by breast care nurses and geographical residence as moderators of the unmet needs and self-efficacy of Australian women with breast cancer: Results from a cross-sectional, nationwide survey. Eur J Oncol Nurs. 2016;23:72-80.

8. Koçan S, Gürsoy A. Outcomes of Breast Care Nurse Training and Follow-up: Body Image, Anxiety, and Quality of Life. J Educ Res Nurs. 2023;20(1):52-9.

9. Mahony J, Masters H, Townsend J, Hagerty F, Fodero L, Scuteri J, et al. The Impact of Breast Care Nurses: An Evaluation of the McGrath Foundation’s Breast Care Nurse Initiative. Asia Pac J Oncol Nurs. 2019;6(1):28-34.

10. Australian College of Nursing. Graduate Certificate in Breast Cancer Nursing Canberra, ACT: ACN; 2023 [Available from: https://www.acn.edu.au/education/postgraduate-course/breast-cancer-nursing.

Authors:

Ms Meron Pitcher MBBS FRACS, Head of Unit, General and Breast Surgery, Western Health, Footscray, Vic 3011, Australia, Meron.Pitcher@wh.org.au

Ms Lisa Matar RN, Breast Care Nurse Consultant, Western Health, St Albans, VIC 3021, Australia, Lisa.Matar@wh.org.au

Ms Sue Komp RN, Breast Care Nurse Consultant, Western Health, St Albans, VIC 3021, Australia, Suzanne.Komp@wh.org.au

Ms Sara Jorgensen RN, Former Clinical Nurse Consultant Manager, Western Health, St Albans, VIC 3021, Australia, Sara.Jorgensen@monashhealth.org

Dr Sara Holton PhD, Senior Research Fellow, Deakin University, Institute for Health Transformation, Centre for Patient Quality and Safety – Western Health Partnership, Geelong, VIC 3220, Australia, s.holton@deakin.edu.au