A day in the life of a Colorectal Clinical Nurse Specialist (CNS)

My name is Rebecca Costello and I'm a Colorectal Clinical Nurse Specialist (CNS) at Stockport NHS Foundation trust. I'm going to tell you a bit about an average working day for me.

6.30am

I get up and get ready for work. On the way in, I have time to reflect. This particular morning, I'm thinking how it's been 21 years since I qualified. After my gran died suddenly, I made a big change. I'd been working in the textile industry, and I decided to have the courage to follow my dream of working as a Nurse.

My journey working with patients diagnosed with cancer began as a student when many of my placements were at The Christie. My first job there was on the surgical wards. Then in 2006, I started work as a CNS at Stockport. It combined all the things I love about nursing – supporting patients through their cancer journey and providing access to information and advice about diagnosis and treatment.

8am

I arrive at work and make a coffee, it's essential at the start of a busy day. We're a small team with five staff in today. Today it's my role to allocate work in the morning huddle. Two of the team will call patients who've had their bowel cancer treatment and are on surveillance to assess their current symptoms, and order any tests such as CT scans, bloods and endoscopic investigations. They will also discuss the emotional effects of bowel cancer, and refer people for counselling or a Holistic Needs Assessment (HNA) to help with anxiety and support with their emotions. Enabling patients to talk though their needs and feelings and access services that can support them is an essential part of the role.

We normally see new patients in the outpatient department. Today I will be introducing myself to patients along with our Colorectal Consultant Surgeons. We're covering three morning clinics and will be seeing up to eight patients. Some will be receiving test results and a new cancer diagnosis, some will be getting their post operative histology and finding out if they need adjuvant chemotherapy, and others will be getting the results of surveillance scans. It often causes anxiety waiting to hear the results of the biopsies and scans, so we make sure that our patients know what the next step is, how to access information and how to contact the team.

I always say, "No question is silly or too small, our job is to try and answer any questions and get you the answers you need."

The next patient I'm seeing is someone I met when they were first diagnosed. I love this continuity of care. The patient has recovered well from their surgery. We give them their results: the tumour has been removed completely and they don't require adjuvant chemotherapy. This means our team will now follow up with them for the next five years with regular appointments and tests.

12.30pm

Clinic has run all morning. We document our patient contact and get a quick bit of lunch. We're lucky to have a quick half hour break – often the clinics overrun, and we have to go straight into the afternoon's commitments.

I quickly check my emails before the afternoon clinic. Greater Manchester Cancer Alliance have been in touch about National Cancer CNS Day because I'm helping plan what we're doing locally. I've also had the list through for the patients to be discussed on the Multi-Disciplinary Team (MDT) meeting this week. I need to look at all the patient tests and investigations so I can be the patient's advocate and we can plan the next steps of their treatment. We've introduced a 'patient impact statement' and I need to make sure I have these printed off and prepared for the MDT meeting so that we can voice the patients concerns and needs.

1pm

I have a face-to-face clinic with another Colorectal CNS to see five patients, and then a further five patients in a telephone clinic. Over the last three years we moved all our patient contact from face-to-face, to telephone clinics due to the COVID pandemic, but recently we've introduced a hybrid version offering both. I love seeing patients in person, and I also understand the benefits of a telephone clinic when you have a busy life.

Today many of my patients are two or more years following their surgery, most have no new issues and symptoms, and I can order their scans and investigations. However, one of my patients is still having issues with their bowel function following a lower anterior resection, so I completed a lower anterior resection syndrome scoring assessment and referral to our Pelvic Floor Physiotherapist. I'll arrange a further call in a few weeks to see if the advice I've offered has improved things for them or if further tests and support are needed.

4pm

Clinic finishes at about 4pm. As a team, we talk through the day and support each other with any issues or concerns. Two of my colleagues have got our Bowel Cancer Awareness Month information ready, and set up a trolley to visit the ward. I’m passionate about raising awareness and how to access support.

Well, that's my day done. Back home to sort out the family and walk the dog.

Hopefully this has given a small insight into my job. I love being a Colorectal CNS and I never thought I would be able to do such a role. I have dyslexia which made me reluctant to follow academic study and my nurse training, but I'm glad I made the step and change and hope to continue in the role for many years.