As I end the call and calmly remove my headset, I feel that familiar flush of frustration.
A few deep breaths won’t shift that discomfort – I’ve had the same conversation too many times.
I’ve spent the last five minutes politely explaining to an alarmed nurse that, yes: our job advert for a urology and general surgery staff nurse is correct. Yes: chemotherapy registration is a desirable – you’ll be giving all varieties of treatments for bladder cancers, and yes: male and female catheterisation and complex wound dressings are a requirement too.
And no: the job isn’t just “making doctors cups of tea and supporting the patients”.
Outpatients isn’t what people think it is. There’s so much more to it.
This nurse isn’t alone in her misunderstanding – there’s a general lack of awareness about the work we really do in outpatients, the skills you need, what it teaches you and where it can take you in your career.
The breadth of work might surprise you
Outpatients isn’t what people think it is. There’s so much more to it.
In my team, in any one day we could be carrying out tongue or throat biopsies with disposable cameras, using microsuction to remove earwax and assess ears for cholesteatomas, or scrubbing in to assist with skin grafts under local anaesthetic.
We're trying to create more theatre capacity by bringing certain procedures into outpatients, too. So, our general surgery nursing staff are now working with a consultant or registrar to remove lipomas and superficial tags.
Then there’s our team of oncology specialist nurses, who are supporting patients throughout every aspect of their cancer journey.
Don’t dismiss a career away from the wards
You might have heard colleagues say, “Oh, day surgery is just tea and toast... that's all the nursing staff do there”. And that outpatients is where you go when you can’t perform on the wards any longer, or if you've got a back injury, or you’re coming to the end of your career and you just want to slow down a little bit.
Some worry they’ll de-skill. The reality is – you’ll specialise
That’s what I was told when I worked on the wards and first applied for a role in day surgery. I was newly qualified and young, my team couldn’t understand my move away from the wards. Then, when I moved again from day surgery to outpatients – colleagues said it would ruin my career.
But working in outpatients opened my eyes.
Specialising, not generalising
There’s no need to stagnate when you work in outpatients. There are options, there are opportunities, there’s progression – if you want it.
Some worry they’ll de-skill. The reality is – you’ll specialise. When you progress as a nurse, much of the time, you progress away from nursing and into management. In outpatients, you progress clinically within your field of expertise.
She now works at the top of her license and it all started in outpatients
Our urology nurse consultant started as a band 5 after qualifying on an orthopaedic ward. She came to work with us in urology as a sister, went on to be the department lead and got a trainee urology nurse consultant post. Now, she works at the top of her license and it all started in outpatients.
She’s now performing trans perineal prostate biopsies; and, with a team of nursing staff around her, she offers flexible cystoscopy clinics. She also runs telephone clinics – giving patients MRI results, attending multi-disciplinary meetings, and supporting patients in every aspect of their cancer diagnosis journey.
She’s not our only success story; there are so many nurses who’ve experienced a similar career trajectory while working in outpatients.
Progression for all nursing staff
Working in a specialist area means learning additional skills. Band 3 nursing staff can take on further skills too, like male and female catheterisation, and after appropriate training, teaching patients intermittent self-catheterisation.
Outpatients has taught me to expect the unexpected
We’ve got plaster technicians that came to my team as band 2 health care assistants who now know every single bone in the body and can assist in manipulating bones that need to be reset. They do some dressings, remove stitches and clips, and they achieve the qualifications to back up those skills and many have progressed to band 4.
Keeping you on your toes
Outpatients has taught me to expect the unexpected. You never know who’s going to come through the doors – when I worked on the wards direct admissions were very rare, so I knew my patients.
In outpatients, you won’t know a patient’s general health. Yes, you might have their medical notes, but in a 10 to 15 minute appointment, you've got to be able to build that relationship instantly with people and earn their trust.
My team of nurses do that 12 times in the morning and 12 times in an afternoon, every single day. That’s a phenomenal skill in itself, but they’re also delivering impeccable care to the standard and quality that I’d wish for my own family.
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We recently set up a community diagnostic centre that’s completely nurse led. It offers a one-stop shop for patients on the two-week cancer pathway. In one day, patients can potentially leave with a diagnosis, the all-clear, or signposted and referred onto another service.
The nurse consultant and her team of nursing staff offer flexible cystoscopies, bloods and ultrasounds, and in the future we hope to offer MRI scans on the day, too.
You get to be the person they remember for a good reason during a bad time
We’ve set this up ourselves as outpatient nurses (with some help from the improvement team), and we did it in just eight weeks – from exploring what we needed to delivering the service. When we trialled it a couple of years ago, the service saved 18 days (per individual) on the two-week wait pathway, from when patients had their first investigation to receiving a diagnosis.
One-to-one quality care
In outpatients, you’re able to focus on the quality. You get the opportunity to make sure your patient fully understands what's been said to them, what the next steps are, and get to be the person who can hold their hand and the person they remember for a good reason when they're going through a bad time.
Surgical outpatients is just a tiny aspect of what goes on at my hospital and we’re just a small district general hospital, but it’s clear for anyone to see – we’re doing so much more than switching on the kettle.
