A day in the Life of RANP, Symptomatic Breast Unit - Nichola McNamara

My name is Nichola McNamara. I am a Registered Advanced Nurse Practitioner (RANP) in the Symptomatic Breast Unit at University Hospital Limerick (UHL). I started my career working in cancer services, mostly administering chemotherapy in the Haematology Oncology Day unit, before transferring to the Breast Unit in 2018. I have two young daughters, so life outside of work is busy, mostly spent in the car driving to children’s activities and parties. I love music and getting to live gigs whenever I can. I think it’s important for us all to take time to mind ourselves and do something we enjoy out of work.

What a typical working day involves

The Symptomatic Breast Clinic is an outpatient-based service and we review over 9,000 patients every year. I have a fantastic working relationship with my colleagues, including the Breast Clinical Nurse Specialists, Clinical Nurse Manager (CNM2), Consultants, Surgical team and Administration staff. We run approximately seven clinics per week. My duties as an ANP include reviewing patients in clinic with benign and malignant breast disease.

My typical day involves meeting patients, taking a clinical history, performing breast examination, requesting imaging and liaising with GPs. Health promotion is a major part of my role; educating every woman I review on the symptoms of breast cancer and how to perform monthly self-breast examination. This empowers women to confidently take control of their own health and not be over-reliant on clinicians.

What I enjoy most about my work

I have a strong interest in hereditary breast cancer and genetics and I am a member of the National Family History Steering Group. My main cohort of patients are women at risk of hereditary breast cancer, either due to genetic mutation or high family prevalence. What I enjoy most about my work is getting to know my patients. With genetic carriers, I often meet multiple members of the same family every year and they like to have that continuity of care. Women with a genetic mutation often must engage in difficult decision-making, such as risk-reducing mastectomy, and require a lot of support and guidance. I have developed a good and trusting relationship with these patients and it reassures them to know they can pick up the phone to me at any time if they have a breast problem in between clinic visits.

My favourite part of my working day…

My favourite part of my work is when I make a difference to the lives of patients and their families. This might involve doing something small for a patient, like referring them for a complementary therapy and it’s nice to get feedback that it helped them. Women who are on five-year follow-up care plans can really struggle psychologically after treatment for breast cancer. My role is to listen carefully to their experiences, and advise them of what to expect during the follow-up plan. It’s important that these women are aware of survivorship programmes and are offered health promotion advice as they begin the survivorship journey.

My most exciting career moment to date..

Graduating with an Advanced Nursing Masters in NUIG was my most exciting career moment to date. It wasn’t easy being a working mother and studying for a Master's so it meant a lot. I really enjoy learning and have recently started a Postgraduate Certificate in Cancer Genetics and Genomics with RCPI, so I’m not quite finished studying yet! Overall, I feel it’s worth it as the ANP service has positively impacted our unit by improving the patient experience, reducing waiting list times while also promoting the evolving role of the nurse.

A key focus

We are now looking towards commencing virtual clinics for patients at risk of hereditary breast cancer. Currently, a new GP referral electronic form is being compiled by the National Cancer Control Programme. This means a patient who is concerned about family history of breast cancer can be referred by the GP to the virtual breast clinic, and will not have to attend in person unless there is a clinical concern. To facilitate these new clinics, a Clinical Nurse Specialist in Hereditary Breast Cancer, Lynn O’Brien, has recently been appointed in the breast clinic. Lynn and I will be working closely with the Consultant Breast Surgeons to decide the appropriate care for these patients and roll out these new nurse-led virtual clinics.

October is Breast Cancer Awareness month, so just a reminder for women (and men) to check their breasts every month. For women, a week after menstrual cycle is best. Any concerns should be relayed to their GP. For further advice on breast examination, see link: https://www.cancer.ie/cancer-information-and-support/cancer-types/breast-cancer/how-to-check-your-breasts