The question of role overlap is central to the success of the SBN role. In most interviews, perceived role overlap was seen as a positive aspect of the SBN role. This was because the overlap was held to be in the best interests of women. Overlap occurred mainly in relation to information giving: SBNs were seen to give the same information as a range of other health professionals, including surgeons, oncologists, physiotherapists and social workers, or were seen to repeat to women the treatment plan decisions made by the treatment team. As is evident in the quote below, this doubling or reinforcing of information was described as positive, as it is recognised that patients often retain only a small amount of the information from medical consultations, particularly at diagnosis.
Medical oncologist: Patients and families often need things repeated on a number of occasions … I think what is important is that the [SBN] could … reinforce … what people are being told … Information has to be given and sometimes information is given differently by different people, people feel less threatened by information given by one person versus another, so I think it ought to be an additive, if not a synergistic role, rather than a competitive role … [the SBN] needs to have discussed that with the multi- modal team who’s going to make … the ultimate treatment
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e
In other cases, information on the same issues given by SBNs was not seen to be a negative overlap because the information given by SBNs was more general, whereas that given by other specialist treatment team members was more specific to that woman’s situation. This happened, for example, in relation to arm exercises prescribed by physiotherapists, who reported that women came to physiotherapy with a useful general understanding of arm exercises, which they then made more specific.
Other positive role overlap occurred in relation to discharge planning (as reported by discharge nurses) and in relation to dealing with families and friends (as
reported by a nurse unit manager). The overlap in regard to these more practical organisational issues was again seen as helpful to, rather than hindering good patient care.
There was also some complementary overlap in the area of emotional or psychological care, although allied health professionals made clear distinctions between the interventions they provided and the support role of the SBN:
Psychologist: I guess the way it complements is that we have confidence in each other’s skills and resources. I am confident that [the SBN] is able to recognise where emotional support is not enough and patients actually need … psychological intervention … We know each other’s roles and we know what is appropriate and what is expected and what is intrusive, and we deal very openly and honestly with each other on those levels.
BCSS volunteers also made a distinction between the support they offer to women and that offered by SBNs. As one volunteer remarked, “The role that the volunteer provides is somebody who’s had treatment for breast cancer … It’s a very
particular kind of role.”
Some aspects of role overlap were seen as less positive, and conflict around role boundaries was reported in a few instances. In most instances, however,
negotiations between SBNs and treatment team members led to a successful resolution of these issues. In these cases, the problem seemed to relate to role development and the uncertainty caused by the new role. In centres where a nurse had been working in a similar position before the project, there were fewer, if any, instances of such conflict.
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e
Clinical nurse specialist (CNS)(Oncology): I think it was a bit hard at first to work out exactly where she was going and where we were going with our roles and then once we sorted that out it sort of worked a lot better …
Interviewer: And how did you deal with the overlap … ? What did you actually do? …
CNS (Oncology): We’d sit down and discuss it …
Interviewer: … What caused the actual problem? …
CNS (Oncology): Oh, I think neither of us was prepared. We
probably should have sat down and discussed it more before the [SBN] actually started.
Interviewer: How did you and the [SBN] deal with the overlap?
Social Worker: By setting clear contracts with each other about what each of us were doing, what tasks we were undertaking and what follow-up we would each provide. So just clear communication and coordination of the intervention plan.
In rare cases where role conflict was reported as having been neither resolved nor improved, infrequent contact and lack of previous experience with SBNs appeared to be significant factors. In one isolated case, communication problems between the SBN and a surgeon led to confusion regarding role boundaries:
Surgeon: She’s been given roles that are actually the doctor’s role largely, or were done, previously done and are still being done, by the doctor and there was therefore a duplication. Now from my own point of view, I didn’t feel it was important that my role be replaced. Or that someone else come and do my job.
Conclusion
Role overlap, in general, was seen as a positive aspect of the SBN role, as long as such overlap did not create confusion regarding role boundaries and core tasks. The development of the role to suit different treatment centres and teams, and the development in each team member of a full understanding of the SBN role, are clearly essential to the successful functioning of the SBN.
C h a p t e r 5 : H o w t h e t r e a t m e n t t e a m a n d s p e c i a l i s t b r e a s t n u r s e s v i e w t h e s p e c i a l i s t b r e a s t n u r s e r o l e