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I have been asked to explain my role on many occasions, and so was very enthusiastic when Yorkshire Cancer Network (YCN) decided to pilot Pandora across the network.
Pandora is a browser based software program designed to capture expertise and demonstrate the complexity of the clinical nurse specialist (CNS) role.
The main aim was to show fellow professionals what the network’s CNSs did in a more measureable format.
We recorded data over a 20–30 day period. I hoped it would lead to some meaningful data on my day-to-day work, and add to my annual report.
Pandora requires the user to record details as ‘events’ and has boxes to fill in around topics such as emotional effort, research, audit, administration, clinical work, consultation and education. I found the free text boxes very useful, as sometimes the other options did not meet my needs.
We were given written instructions to follow, but after talking to colleagues, it became apparent that we were all entering data differently, despite the specificity of the database. For example, when recording time spent in the outpatient clinic, I noted this as a ‘high emotional effort using clinical expertise’ with ‘consultation’ as my intervention, along with a recorded time of two hours plus. I would then add detail about the nature of consultations and specific interventions used with each patient. These included giving bad news, giving written information or specific clinical interventions. Alternatively, my colleagues were entering each patient seen in clinic separately – there seemed to be no right or wrong way.
My colleague Lynne Jackson, Macmillan Gynaecology Clinical Nurse Specialist, commented, ‘It is an individual and very subjective view that is being documented. What one CNS deems to be high level, another may think is medium or even low. This means that it’s impossible to compare with other CNS workloads.’
Colleague Marion Webb found that she had not been given enough time to view the training material. She said, ‘It became evident that the teams were collating data differently and the actual recording of events was very fragmented.’
Entering the data was time consuming, taking between 30 minutes to one hour. I always entered phone calls with a patient as a separate event, with text to give detail as some calls could be long and require a high emotional effort.
I was enthusiastic about Pandora and still feel it has merit, particularly if more training is given. However, it has not provided any comparable data about my role, and I believe that this is due to the variations in data entry by the CNSs. We can still collate our own data, which I will use in my annual report and to prepare for peer review.
Contact Beverly Hurst, Macmillan Gynaecology/ Oncology CNS at Bradford Hospital (email Beverly).|
Dr Alison Leary and Susan Oliver. Clinical nurse specialists: adding value to care|. 2010. Royal College of Nursing, London.
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