Fast Facts: Dermatological Nursing: A practical guide on career pathways

By S. Karger

Providing dermatology care to the large number of people with skin disease requires a workforce that is appropriately trained and competent to meet patients’ needs safely and effectively. Nurses form a critical part of the team that provides that care and they are increasingly developing new skills and approaches that complement the skills of the other healthcare professionals they work with. Here, we aim to provide practical guidance for developing these more advanced roles, with signposting to additional resources. After reading this Fast Facts resource, dermatology nurses will: • be aware of a variety of career pathways in subspecialist dermatology fields • have a clear understanding of the clinical skills required in these areas • know how to proceed with their training. Table of Contents: • Succeeding as a dermatology nurse • Practical skills • Skin cancer • Skin surgery • Phototherapy • Monitoring systemic therapies • Paediatric dermatological nursing • Lower limb management

• Language: English
• Publisher: S. Karger
• Release date: Nov 30, 2022
• ISBN: 9783318071726

Book preview

Introduction

Providing dermatology care to the large number of people with skin disease requires a workforce that is appropriately trained and competent to meet patients’ needs safely and effectively. Nurses form a critical part of the team that provides that care and they are increasingly developing new skills and approaches that complement the skills of the other healthcare professionals they work with.

Here, we aim to provide practical guidance for developing these more advanced roles, with signposting to additional resources.

It should be noted that the roles and responsibilities outlined throughout this resource will vary according to service needs in different regions and places of work, and should be seen as a guide rather than definitive job descriptions.

As well as detailing the competences that must be demonstrated by individual nurses moving into new roles, this concise resource considers the organisational responsibility required to ensure that these more advanced roles are undertaken against a backdrop of effective clinical governance.

After reading this Fast Facts resource, dermatology nurses will:

be aware of a variety of career pathways in subspecialist dermatology fields

have a clear understanding of the clinical skills required in these areas

know how to proceed with their training.

Dermatology offers many exciting career pathways in which nurses can fully utilise their nursing skills. We hope that this will be a valuable resource for any dermatology nurse looking to develop their career.

1Succeeding as a dermatology nurse

Rebecca Penzer-Hick RN MSc

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

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