Guidance on commissioning cancer services: an investigation of the implications for nursing

Objective: to explore the potential of national guidance to enhance nursing contribution to interprofessional co-ordination, utilising the NHS Executive Guidance on Commissioning Cancer Services for breast, colorectal and lung cancer as an exemplar.

Design: a thematic analysis was conducted of each of the guidance documents. The direct and indirect references made to nurses and nursing were identified and categorized. Matrices were used to display data (Miles & Huberman 1994).

Results: although direct references to nurses were present in a proportion of the topic categories there were many more instances where the necessary nursing input was implied rather than explicit. The main implications for nurses and nursing were identified in five topic areas; communication, implementation of policy, psychosocial support, cross membership of teams, and partnership with patients.

Conclusions: this analysis has provided evidence that nurses are integral to the implementation of most areas of care in all three of the cancer guidance documents examined. However, because many of the references to the nurse’s role have been identified as indirect or implied this leaves room for uncertainty in terms of identifying nursing involvement in cancer care. In particular, it is argued that the explicit nursing role in implementing guidelines has been hidden within the term ‘team’. It seems likely that nurses in senior positions may need to negotiate with colleagues in order to make their role explicit so that they can make a meaningful contribution to guidance implementation.