Succeeding as a dermatology nurse

Dermatological conditions affect all ages, races, ethnicities, sexes and genders. This means that the dermatology nurse needs multifaceted skills to manage both the physical and mental sequelae of skin conditions, along with a deep empathy for what it means to live with skin that can feel profoundly uncomfortable both physically and psychologically. Whether it is a child with eczema or an elderly man with skin cancer, dermatology nurses must be knowledgeable about therapeutic interventions and able to provide psychological care to support mental health wellbeing.

The challenges posed by the needs of such a diverse patient group are, in part, what makes dermatological nursing such an interesting and satisfying specialty to work in. This book aims to outline the many and varied possibilities open to nurses who join this specialty. For those who are already working in dermatology, it will provide a guide to help with career development, providing insights into key aspects of dermatological nursing with suggestions for developing new skills and knowledge.

The state of dermatological nursing in 2022

In many respects, dermatological nursing is currently in a strong and vibrant position. There are numerous possibilities for role development: the British Dermatological Nursing Group (BDNG) has more members than ever and the number of opportunities for education and research continue to grow.

However, there are also unprecedented challenges. Before the coronavirus (COVID-19) pandemic the specialty was struggling with workforce issues and an increased demand for its services. The GIRFT (Getting It Right First Time) national report on dermatology, published in 2021, highlighted some of the challenges, including shortages of consultant dermatologists, a significant increase in the number of patients with suspected skin cancers, greater access to new drugs meaning more people who could be successfully treated and, in general, a higher expectation from the public to resolve their dermatological issues.1 On top of these challenges have come the huge pressures of managing the consequences of the pandemic.

In this book, dermatology nurses write about how they continue to provide excellent care for patients with skin conditions despite these challenges, nurses who have worked with other members of the

multidisciplinary team (MDT) to find new ways to meet the needs of patients.

Dermatology nurses, regardless of their band, have an incredibly important role in making sure that patients with skin disease access the right care, at the right time and in the right place. As the opportunities for developing new roles in dermatological nursing increase, there needs to be an ongoing push to encourage more nurses to join the specialty.

The patient care setting

Dermatological nursing is predominantly an outpatient specialty, which means that most patient care is undertaken in outpatient departments of hospitals. However, dermatology nurses also work as part of specialist services in community settings, private healthcare, aesthetics and the pharmaceutical industry. There are very few dedicated dermatology inpatient facilities; patients with serious skin disease who require hospital care are usually looked after on a general medical ward. Some hospitals have a liaison nurse who ensures that patients with dermatological conditions on general wards receive the appropriate care.

What skills does a dermatology nurse need to have?

Dermatological nursing rarely requires the delivery of acute care. Most conditions are chronic in nature and therefore of utmost importance is the ability to work alongside patients to find the best therapeutic options for them and to help to optimise their safe and effective use. This includes treatments for patients with inflammatory dermatoses and skin cancer. Excellent communication skills are paramount to facilitate psychological support, adherence to treatment and patient education. Developing more advanced communication skills, for example motivational interviewing or health coaching, are ways of enhancing the care offered to patients.

Specialising within dermatological nursing. When nurses first join a dermatology team it is beneficial for them to gain broad experience of the many different facets of dermatological nursing, undertaking supervised roles in phototherapy, patch testing, leg ulcers, general dermatology clinics and skin surgery. This allows a broad

understanding of the roles available and provides experience of all the possible patient journeys within a dermatology service. Specialising in one or two of the above areas usually happens at the higher band levels, where independent practice and decision-making require depth rather than breadth of knowledge.

There are many opportunities for independent practice within dermatological nursing. As this book will demonstrate, nurses can remain in clinical care to the higher band levels – up to band 8c – and the breadth of clinical subspecialisation within dermatological nursing is wide, with opportunities for nurses to develop skills that best suit their temperament and interests.

As well as clinical care, dermatology nurses practise in research and education and take on leadership roles. Research may be at the level of data collection and patient recruitment for clinical trials, or it may be as a principal investigator leading teams of researchers on bespoke projects. Educational roles can involve delivering local teaching and training within a department, delivering a paper at a conference or working with a higher education institute up to Masters level. Many dermatology nurses use their excellent leadership skills to head up teams and develop project ideas that transform practice.

Whatever your interest, dermatological nursing can provide the relevant opportunities.

BDNG role descriptors. This book makes regular reference to BDNG role descriptors, which, published in association with the British Association of Dermatologists (BAD) in 2020, aim to describe the scope of practice for dermatology nurses from band 5 to band 8.2 These descriptors use Health Education England’s four pillars of practice as a framework: clinical practice, leadership, education and research.3 (While developing the role descriptors, reference was also made to the relevant equivalent documents in other countries of the UK.) Given the clinical focus of the Fast Facts book series, this title focuses on the development of clinical skills rather than the other three pillars. However, as you think about how your career might progress it is important to also consider developing skills in leadership, education and research.

Table 1.1 gives ideas for the kind of educational input nurses will find useful when progressing from band 5 to band 8.

TABLE 1.1

Possible training and development strategies for career progression Band 7 to Band 8

In-house skills training (on the job) BAD conference • International • confer ences NHS leadership academy • training

CONTINUED

Band 6 to Band 7

Nature of role Band 5 to Band 6

In-house skills training (on the job) • Specialised clinical courses • Formal MSc study in advanced practice or dermatology MSc

In-house skills training (on the job)

Clinical • Competency frameworks • BDNG online resour ces • Independent prescribers’ • training BDNG conference •

Specific clinical training modules • Topic-specific study days via BDNG/BAD/sponsor ed events On-the-job improvement pr oject •

BDNG ambassador programme Leadership • Masters-level education module in • leadership Participate in an external gr oup/ • committee Governance and safety •

Audit training • NHS/in-house leadership development programme Become a link nurse or team • lead for a specific area of practice (e.g. infection contr ol)

TABLE 1.1 CONTINUED

Possible training and development strategies for career progression Band 7 to Band 8

Band 6 to Band 7

Nature of role Band 5 to Band 6

Postgraduate teaching qualification

• Make links with higher education for more formal r ole Undertake a teaching qualification •

Mentor training Education • Local teaching and presentation • experience Clinical, service development/change management or audit/resear ch publications UK Dermatology Clinical Trials Network course

Online Centre of Evidence Based • Dermatology education packages Doctoral studies •

Research awar eness course • Literature critical appraisal skills • training National Institute • for Health Research fellowships

Participation in audit exercise •

Research

Terms used

Several terms, detailed below, are frequently referred to throughout this resource.

Scope of practice. To ensure that nurses practise safely and lawfully they should always work within their scope of practice. Scope of practice is defined as an individual’s limits of knowledge and skill set that determine the activities undertaken within their nursing role. Your scope of practice should always reflect the standards set by the Nursing and Midwifery Council in its code of professional practice.4 The BDNG role descriptors describe the scope of practice that is relevant for each band within dermatological nursing.2

Protocols. A protocol usually relates to a specific area of practice or group of patients and is an agreed framework that covers the care that group of patients can expect to receive. Protocols should outline the lines of accountability and should always fit with professional guidance. A protocol should make clear why, when, where and by whom the care is given.

Competence defines the ability of a nurse to deliver care reliably and safely. Competency frameworks break down how each task should be performed into constituent parts that make up the competence needed for safe practice. Competency frameworks may also include knowledge-based competences, which demonstrate the underpinning knowledge required to practise safely. Competences can be measured in several ways to determine the level of competence at a given point in time: for example, an objective structured clinical examination (OSCE). Table 1.2 shows the levels of competence used by the BDNG. In most instances competence must be demonstrated a number of times across different domains. Specific competency frameworks are provided in some of the following chapters.

Who to talk to

In the following chapters, each of the authors offers suggestions as to how to develop skills that will facilitate the development of your career in dermatological nursing. Speaking to others within the profession features highly in their recommendations and a good

TABLE 1.2

Levels of competence

Level Competency

0 Cannot perform this activity in the clinical environment but knows the key principles involved 1 Can perform this activity with constant supervision and some assistance 2 Can perform this activity with some supervision and assistance 3 Can perform this activity satisfactorily without supervision or assistance 4 Can perform this activity satisfactorily with more than acceptable speed and quality of work 5 Can perform this activity satisfactorily with more than acceptable speed and quality of work and with initiative and adaptability to special problem situations

place to start is the BDNG, which can provide direction with regards to educational opportunities and people in your local area who can be contacted for further advice. Joining the BDNG will give you access to all its educational resources, including the quarterly journal Dermatological Nursing. Many employers advertise jobs through the BDNG, and these are highlighted in regular bulletins to members.

Complete novices to dermatological nursing will benefit from contacting their local dermatology unit to see if there are any job opportunities or to see if an informal visit is possible. Dermatological nursing is a small profession but the nurses who work in it are passionate about their specialty and are usually delighted to talk to others about it, encouraging them to join the specialty.

Personal reflection

My career in dermatology nursing has been hugely rewarding. As the brain and the skin are so intimately connected, supporting people with skin disease means understanding and looking after both the psychological and physical impacts.

Key points – succeeding as a dermatology nurse

• Dermatological nursing offers significant scope for developing nursing practice. • Dermatological nursing usually involves non-acute care skills, but there is significant diversity of opportunity in terms of scope of practice, from skin surgery to chronic disease management to paediatric dermatology. • Specific technical skills are needed alongside the more generic abilities of excellent communication skills and empathy for the effects that skin disease can have on patients’ quality of life and mental health wellbeing. • After gaining some general experience in dermatology, specialising in one or two particular areas allows nurses to develop greater levels of independent autonomous practice. • Contacting others in the specialty and developing professional networks will help facilitate individual career development as well as contributing to the overall development of the specialty.

References and resources

1. Levell N. Dermatology. GIRFT

Programme National Specialty

Report. NHS Publishing, 2021. www.bad.org.uk/gettingit-right-first-time-girftdermatology-report-launches, last accessed 1 February 2022. 2. British Association of

Dermatologists Education

Board. Clinical Dermatology

Nursing Role Descriptors:

Guidance on Scope of Practice.

British Dermatological Nursing

Group, British Association of Dermatologists and Royal

College of Nursing, 2020. www.bdng.org.uk/wpcontent/uploads/2020/08/

BAD-BDNG-RCN-NURSING-

WORKSTREAM-A4-

LANDSCAPE-002.pdf, last accessed 1 February 2022. 3. NHS England. Multi-Professional

Framework for Advanced

Clinical Practice in England.

NHS England, 2017. www.hee.nhs.uk/sites/default/ files/documents/multi-profes sionalframeworkforadvanced clinicalpracticeinengland.pdf, last accessed 1 February 2022. 4. Nursing and Midwifery Council.

The Code. Professional Standards of Practice and Behaviour for

Nurses, Midwives and Nursing

Associates. Nursing and

Midwifery Council, 2015. www.nmc.org.uk/code, last accessed 1 February 2022.