Establishing a critical care outreach team, teaching doctors through simulation training and transforming local training courses into digital webinars with nationwide reach
Lara Roskelly is a senior nurse in cancer care at Frimley Health NHS Foundation Trust and she manages a Nurse Led Acute Oncology Service across Frimley Health. Throughout her 21 years working in the NHS, she has helped establish a critical care outreach team for cancer patients that have recently left intensive care, has led university teaching at several universities and has been one of the first nurses in London to train doctors in a simulation centre. She currently manages a number of oncology teams, heads a cancer rapid diagnostic centre and runs training courses nationwide. Lara reflects on the many opportunities available to women who decide to embark upon a career in the NHS.
"Junior doctors didn’t have out-of-hours support so we created the critical care outreach team."
Originally from South Africa, Lara moved to the UK in 2000, where she quickly began working in Intensive Care and Oncology at The Royal Marsden. There she helped establish a new and pioneering service with her colleagues. “We noticed that when people left Intensive Care they often had a higher need for care. Junior doctors didn’t have out-of-hours support so we created the critical care outreach team. I set up a seven-day service across two sites where we would support really unwell patients. It was a fantastic opportunity to create advanced practice roles with very skilled nurses.”
"My students needed real-life teaching, so I got involved in simulation training."
Lara has also worked with the NHS education team teaching advanced nursing practice at universities in London. The experience inspired her to change the way she taught to make it more effective. “I loved being part of the teaching peerage but I felt that my students needed real-life teaching, so I got involved in simulation training. I was one of the first nurses in London who trained anaesthetic consultants to become simulation instructors, and then I helped set up the simulation joint centre in The Royal Marsden and The Royal Brompton. I delivered training for undergrad med students, and first and second year doctors. It is a brilliant opportunity for junior doctors and whole teams to do simulation training together.”
Simulation training consists of creating a lifelike scenario with a mannequin so that medical teams can practise how to manage a medical emergency that includes human factor training. “We have a life-like mannequin that can breathe and cry. We do the voice of the mannequin so that we can talk to the doctors and nurses in the room and create a live environment. We film it and then play back parts of the video during the debrief period and analyse the clinical action and the human factors. You don’t often have a chance in an emergency situation to think about ‘how did I say that to a relative or to a patient?’ It’s a great opportunity to experience a stressful situation without anyone coming to harm because we use a mannequin and an artificial environment. It’s a great form of education.”
"We decided to take it online [because of Covid] ... word of mouth got out and we had GP practices from all over the country attend."
The pandemic has forced Lara to redesign her training and go digital. “I’ve been involved with a project with Frimley Health and Health Education England. We intended to go into GP practices locally and educate primary care teams how to support cancer patients from pre-diagnosis to end of treatment. Because of Covid we couldn’t go into GP practices so we had to redesign very quickly how to deliver this training. We decided to take it online, and we’ve delivered 16 webinars so far, and we’ve had over 1100 attendees at our webinars on oncological emergencies. I think word of mouth got out and we had GP practices from all over the country attend. It’s given me an opportunity to meet up with GPs online, now GPs phone my AOS team after attending the webinars and ask for help with cancer referrals.”
"I’ve never felt disadvantaged because I’m a woman."
As a woman in the NHS, Lara reflects upon the many opportunities available. “I do think medicine is very hierarchical but I’ve never felt disadvantaged because I’m a woman. There are so many different roles in the NHS. Nursing and education are my roles, but you don’t have to have a clinical background to work in the NHS. I do think it is one of the most amazing services in the world. At the heart of it is the people.” #womeninthenhs #unsungheroes #FrimleyHealthNHSFoundationTrust
Genevieve Shaw, editor
g.shaw@womeninthenhs.co.uk
