The Royal Marsden

All about Advanced Practice

Students signing up for our Advanced Practice courses have many questions, so we asked two lecturer practitioners to answer some common queries

Whether you decide to take our Postgraduate Diploma or the MSc in Cancer Care: Advanced Practice, many of the questions you have will be the same. Here, Janice Barrett and Laura Collantes, both Advanced Practice clinical lecturer practitioners, tackle some of their students most common concerns.

Q. One of the most popular modules you teach is physical assessment. Shouldn’t nurses already have this kind of knowledge?

Janice: Although the majority of our students are nurses, we do teach other healthcare professionals, such as radiographers and pharmacists. While most nurses and AHPs have a basic understanding of assessment, this training is to increase the skills they need for assessing patients. It’s very similar to the training that doctors receive.

Laura: Curriculums can also differ between countries and medical schools, so we’re bringing everyone up to the same level, to have a more advanced and more medical understanding.

Q. What do you teach on the physical assessment module?

Laura: It’s a very practical course so the students often practice on each other, which they really enjoy – it’s always a very relaxed atmosphere. We teach them to look at a patient for certain things, such as the colour of their skin or the eyes, examine the nails and fingers, and listen to the chest or abdomen for certain sounds. Tapping the lungs or stomach, or listening with a stethoscope, can reveal so much about a patient. We also have a model of a chest that makes different sounds, like coughing or wheezing, so students can learn to listen for a chest infection, for example.

Janice: The assessment skills we teach are incredibly practical, like feeling an abdomen. It’s very hard to know what an enlarged liver feels like unless you’ve actually felt one on a real patient. We also take students to the anatomy lab at Guy’s and St Thomas’ so they can see real anatomical specimens, and learn all about the body’s different systems – respiratory, cardiac, etc. One of the most common mistakes students make is they assume the lungs are bigger than they are, so when they listen to a patient’s chest, they’re listening in the wrong place. But seeing where the lungs are inside a body gives them a much better understanding. Part of physical assessment training is not just working out what’s wrong with a patient, but also what the diagnosis might be – it’s like an episode of House, where someone walks in and you have to figure out what their symptoms could mean.

Q. You also teach prescribing, which sounds terrifying!

Janice: Students aren’t thrown in at the deep end – they’re taught a lot of pharmacology before they start prescribing. It can be hard work in the classroom, but it’s all going towards being able to prescribe the right drugs for your patient. Nurses already have very good physical assessment skills when they start the course, so when you add in the pharmacology knowledge, they’re able to prescribe what a patient needs. But it can be really nerve wracking the first time you do it – it took me 45minutes to work up to it!

Laura: When I first started I was really excited. I remember saying ‘Let me prescribe a paracetamol!’ Prescribing helps you build a much better relationship with your patients. You can see a patient, assess them and then prescribe what’s needed. It also saves so much time in an emergency situation, as you don’t have to find a doctor to prescribe the medication that you’ve already worked out your patient needs. Prescribing can really build your confidence, but it’s understandable that some people might be scared because it’s a big responsibility.

Q. Do students need to know a lot about drugs before joining the course?

Laura: It can be challenging for a lot of people, as it’s a lot of scientific information to learn. But we have very small groups on the course, not like a big university, so lecturers can spend more time with each student. Pharmacists from The Royal Marsden come across from the hospital to teach students too, so they’re getting the very latest information they need to be successful advanced practitioners.

Janice: It is a steep learning curve but the majority of our students come from an experienced background, with more than three years of working in their speciality. They are already using certain medicines in their clinical areas, so they can tailor their learning to match what they will need to prescribe once they’ve finished the course. We also have a great library team and really supportive knowledge staff to help with the academic side of the things.

Q. How will becoming an Advanced Practitioner help me, and my patients?

Janice: Sometimes our students might already be advising junior doctors what to prescribe, so it can be a lot quicker and safer if they can then prescribe themselves. Becoming an Advanced Practitioner means you can give much more rounded and holistic care to your patients.

Laura: It can develop and improve the service you are giving your patients, and help develop your role and career too. For example, surgical nurse practitioners can also do small surgeries, which saves time and the need for patients to see a doctor. Our Advanced Practice course directly translates into your practice – it’s not like other courses, that are more theoretical, but you will learn exactly what you need to practice and will be able to offer much better care to your patients.