Nurses

Nurses are integral to support, provide and co-ordinate care. 

General aspects are outlined below with points highlighted in Cases for discussion and Nursing notes. 

Nurses working in hospital (ward based, outpatient clinic, day unit, theatres) or the community (primary care, school health, health visitor, home care treatments) or research nurses all play vital roles to support patients and families with musculoskeletal conditions. 

The clinical nurse specialist (CNS) is often the first point of contact for community, school or primary care nurses if there are concerns. Children often have to face multiple episodes of care with investigations, procedures and treatments that can be uncomfortable and frightening at times. Many of the treatments used can be either administered at home or in a local hospital to minimise travel and family disruption. Nurses in the community enable treatment delivery at home; when visiting families they may be required to offer advice and decide whether to administer or withhold treatments (e.g., child is unwell, pyrexial or there is concern about chicken pox or shingles and especially if the child is on a combination of immunosuppressive treatments). 

Roles of the Clinical Nurse Specialist 

• Knowledge – supporting families, nurse colleagues and other health care providers to understand the diagnosis, treatments and management plan. Telephone Helpline support is often provided.
• Co-ordination of care – treatments to be started, ongoing support / coordination and often linking with nurses on the ward, in shared care hospitals and in the community. The CNS is often the coordinator for Transitional care clinics. 
• Support and guidance – helping families when they are worried / concerned. Telephone Helpline access is often provided. Supporting children receiving day case treatments.
• Training patients, families or local nurses to deliver treatment at home.
• School support – contact with schools / nurseries so that the child is able to fully participate, advice on when to be concerned and how to seek advice.
• Contact between consultants, members of the MDT and families.
• Safeguarding support and advice within the community – child protection meetings.
• Joint injection lists - administration of inhaled analgesia or performing joint injections.
• Cannulation and venepuncture administration of infusions.
• These roles may take place in the specialist centre, outreach clinics or in the community.
• Many specialist services offer Nurse-led clinics.