Guidance

Appendix 1: Breast screening clinical nurse specialist mandatory requirements

Updated 16 December 2019

This appendix lists the requirements for the clinical nurse specialist (CNS) role and details of how those requirements are demonstrated.

Mandatory requirements

1. Women recalled for assessment must be made aware that a CNS is available to them at the point of recall. This is demonstrated by contact details for the CNS being provided in the recall to assessment letter.

2. The CNS must meet women at the start of the assessment process to help manage their anxiety and distress by providing appropriate information and psychological support. Records must reflect the involvement of the CNS and that all recalled women have met the CNS at the start of the assessment process.

3. The CNS must record physical, psychological and social history for all women seen at assessment. The CNS must make sure that other members of the assessment team have access to this information. Documented evidence within the screening or nursing records must show that this history has been taken. Appropriate referral mechanisms must be in place and evidenced.

4. The CNS must speak with women who undergo a needle biopsy at assessment. This is demonstrated by documented evidence of the discussion being available and contact details for the CNS being given to women awaiting biopsy results.

5. Appropriate facilities must be available for the CNS to hold private consultations. There must be evidence that appropriate private facilities are available.

6. The CNS must assess women’s information requirements and offer appropriate verbal and written information. Records must reflect this information given by the CNS. User experience surveys should reveal that the information received was appropriate.

7. The CNS must discuss the diagnostic process and ongoing care with women and provide support throughout the decision-making process. Records should reflect CNS involvement in this area of care.

8. The CNS must be present when women are given a diagnosis of cancer. The CNS assesses the woman’s information requirements and offers appropriate verbal and written information. Records must reflect the information provided by the CNS.

9. The CNS must be a core member of the MDT and contribute to discussions regarding the ongoing care of women. The meeting register for the MDT must record the regular presence of the CNS. The outcome of MDT meeting discussions must be recorded in a single record which is available to the full team.

10. Appropriate documents must exist to record details of the support and information provided. This information must be shared with the symptomatic CNS to enable ongoing care of women after assessment and diagnosis. The CNS records must reflect the information and support given, including evidence of referral to a symptomatic CNS where appropriate.

11. The service must make sure that all women who return to routine screening following assessment know how to contact a CNS. The results letter given to women must include the contact details of a CNS.

12. Nursing protocols must be incorporated within the quality management system for the service. This requirement is demonstrated by nursing protocols being documented and reviewed

Education and teaching role

1. The CNS must make every contact count to promote a healthy lifestyle and patient education. They should lead the development of patient-focused education, including training, to self-manage the ongoing consequences of treatment. There should be evidence that appropriate verbal and written information has been passed to the woman to demonstrate that this requirement has been met.

2. The CNS contributes to the overall development of the breast screening programme through their involvement in teaching and education, particularly in relation to psychological care and information giving. The CNS provides specialist education and training to other professionals involved in patient care and influences the development of others through education and training.

This requirement is met by the provision of evidence:

• of formal or informal teaching
• that appropriate study days or courses have been undertaken
• showing personal responsibility for lifelong learning and personal development
• of engagement with learning and development opportunities

Audit or research role

The CNS must be able to demonstrate evidence-based practice. There should be evidence of relevant audits relating to care pathways, such as surveys of women’s experience.