Day in the Life of an Advanced Nurse Practitioner

Karen Ives-Smith, Advanced Nurse Practitioner in Breast Care & Trade Union Representative, University Hospitals of Derby & Burton NHSFT, provides a detailed look at what a typical day in her nursing role involves. 

My Day-to-Day

My working day usually starts with logging on to the nearest computer in the workplace, to check both my personal work email and team email to see if there are any emails which require actioning urgently.

My weeks are varied with no two weeks the same in relation to activity. I see patients in 2ww (one stop) clinics, breast cancer follow up clinics, breast pain clinics, genetic testing clinics for PARP inhibitor treatments and nipple/areola tattooing clinics.

I provide care for patients with symptoms of suspected breast cancer, benign breast conditions, isolated breast pain, and for follow-up after breast cancer treatment.

My Role

As an Advanced Nurse Practitioner (ANP) with previous Breast Clinical Nurse Specialist (CNS) experience I’m able to provide emotional and psychological support to patients in a variety of clinic settings within the speciality of breast care. Practically, I assess, diagnose and advise regarding treatment of benign and malignant breast diseases. I am also able to prescribe medication (which was the hardest course I have ever done!), request imaging such as CT CAP, CXR, MMGs/USS, breast MRI, bone scan and dexa scans as well as appropriate blood tests as required. 

I work as part of a team of four other ANPs as well as a multidisciplinary team in relation to breast such as breast surgeons, radiologists, oncologists, breast care nurse specialists, imaging department assistants, navigators, radiographers, prosthetic fitters and multiple administration staff.

My Clinical & Support Duties

• I am occasionally asked to assess wounds at the request of Breast CNS’s if antibiotic treatment may be required. 
• I am trained to aspirate seromas however this is generally done by Breast CNS’s.
• I am trained to undertake tissue expansion however this is generally undertaken by our breast surgeons post COVID-19
• I undertake 3D nipple/areola tattooing.
• I am trained to carry out bra and prosthetic fitting however this is generally undertaken by our prosthetic fitter. 
• I am able to assess patients’ needs for counselling and refer to a Breast CNS or to clinical psychology team. I provide emotional support during clinic attendance or over the phone as required but will usually refer to Breast CNS for additional support.
• I work as part of a team of ANPs to see patients face-to-face in breast cancer follow up clinics. We also respond to multiple email and phone call requests to discuss endocrine treatments, side effects and potential options re treatment breaks, switching treatment or stopping treatment altogether.
• As a team of ANPs we identify patients for any current and relevant research trials. I undertake audits as required.
• I teach a variety of healthcare professional within my clinics, from medical students, radiography and nursing students.

My Reflections

• Both my ANP and trade union role can be emotionally draining but extremely rewarding. Clinical supervision sessions are offered however I have only attended a couple of these. 
• Since I started in breast care 25 years ago, the complexity of breast cancer treatments has significantly changed and hugely increased. In relation to patient information, I try to find out from the patient what is important to them first then start from there.
• Balancing my workload is sometimes difficult as I have access to my work emails on my mobile – note to self – don’t access emails when not on shift!